Dear Doctor
This is Reem Ahmed and I like to explain briefly and send the medical report of my brother, Ayman Ahmed, who is under treatment as he has advanced extranodal NK/T cell non-Hodgkin lymphoma nasal type with CNS and testicular involvement. His case was discussed in the Tumor Board and he was planned to be started on SMILE Protocol with intrathecal chemotherapy and this to be followed by high-dose therapy/autologous stem cell transplantation if he achieved rmission to chemotherapy. He tolerated his chemotherapy fairly well with remarkable clinical evidence of disease regression as noticed by disappearance   of oral cavity ulcers and skin lesions. At the time of starting his fourh and last cycle 3of chemotherapy he started to have progressive worsening of lesion at the right eye. There was no clinical finfing elsewhere. He was assessed by Ophthalmology with finding of vitritis with multiple whilish lesions  in the retina.Repeated assessment with orbits MRI and brain MRI showed findings consistent with bilateral lymphomatous infiltration of the posterior globe with secondary right retinal detachment and increased enhancement in the internal auditory canal with leptomeningeal infiltration. He went for surgery where he had vitrectomy and multiple biopsieswere taken and it showed evidence of lymphoma as well as cytology from the vitreous fluid by flow cytometry was positive for lymphoma. Repeated assessment showed negative bone marrow piopsy. We discussed again in the Tumor abroad an Ayman was planned to have radiotherapy where he was started on emergency-based radiotherapy on 14 of July 2017. We are seeking your recommendation what can be done. So far we have some options.(Medical report is available, kindly we need email address to send it)
1- if his PET scan is negative we will consider to go for stem cell mobilization/collection with high-dose cytarabine followed by BEAM conditioning and autologous stem cell transplantation.
2- HLA tissue typing for patient and his three siblings is pending. Allogenic stem cell transplantion is a considered option despite the logistic issues where he is not eligible to do it in our center and it might be difficult for him to go abroad in early time.
3- Pralatrex is available in our center and considered to be alternative option.
4- Novel agents like using PDI inhibitors also discussed based on recent encouraging results in ongoing clinical trials. What is available is Nivolumab and this option also could be considered in the future.
Thanks alot for your time. Medical report is available.