Personized Diagnosis And Treatment Research Of Rare Refractory Hematological Malignancy (High Risk Myelodysplastic Syndrome; Lymphoma With Central Diabetes Insipidus)

Objective:To evaluate the clinical efficacy and safety of arsenic trioxide, retinoic acid and thalidomide combination therapy in high risk myelodysplastic syndrome.Methods:Twenty-one patients diagnosed with high risk MDS were administered 10 mg/day arsenic trioxide intravenously for 10 days,40 mg/day retinoic acid orally for 2 weeks and 100 mg/day thalidomide orally for 4 weeks per cycle.Results:After at least two treatment cycles,10 patients showed hematological responses. One achieved CR, one achieved PR, and three patients achieved major hematological improvements. The efficacy rate was 24%(5/21), and the response rate was 48%(10/21). The schedule was tolerated well by all patients and toxicities were moderate and reversible.Conclusion:The combination of arsenic trioxide, retinoic acid and thalidomide could have therapeutic benefit in higher risk MDS with safe Introduction:Non-Hodgkin's lymphoma (NHL) presenting with diabetes insipidus (DI) in consequence of hypophyseal lesion is rare. Up to now, only thirty-three cases in the English literature have been reported. Here we reported two patients with presentation of DI and pituitary involvement from systemic advanced high risk NHL. Their clinical features and therapeutic responses were described. Both were of B cell origin in pathology and showed abnormalities on brain MRI scanning with lack of the normal hyperintense signal at the posterior pituitary. Case 1# had enlarged pituitary stalk; Case 2# had nodular lesion in the inferior region of the hypothalamus and an empty sella with flattened pituitary. Both patients obtained partial remission symptomatically with chemotherapy and DDAVP. The episodes of lactic acidosis during clinical course in case 1# were even rarer and were corrected by chemotherapies in emergency. This was the first case of Burkitt lymphoma with central DI and lactic acidosis worldwide.