Sekiguchi Yasunobu, Shimada Asami, Ichikawa Kunimo, Wakabayashi Mutsumi, Sugimoto Keiji, Kinoshita Ayako, Suga Yasushi, Tomita Shigeki, Izumi Hiroshi, Nakamura Noriko, Sawada Tomohiro, Ohta Yasunori, Komatsu Norio, Noguchi Masaaki
Department of Hematology, Juntendo University Urayasu Hospital Urayasu, Chiba Prefecture, Japan.
Department of Dermatology, Juntendo University Urayasu Hospital Urayasu, Chiba Prefecture, Japan.
Int J Clin Exp Pathol. 2014 Aug 15;7(9):6278-90. eCollection 2014.
A 70-year-old man presented to us with the chief complaints of a generalized rash and a mass in the right clavicular region that he first noticed in the year 2012. Biopsy of the mass led to the diagnosis of cutaneous nodular mass-type adult T-cell leukemia/lymphoma (ATLL) in March 2013. Phototherapy was started, and the symptoms improved temporarily. However, in late June 2013, the serum lactate dehydrogenase (LDH) level increased to 358 IU/L, which was 1.6 times higher than the upper limit of the reference range; based on the findings, transformation of the disease to the acute type was diagnosed. The patient was treated with 6 courses of CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone), which resulted in complete remission (CR). However, the rash recurred in late October 2013, and treatment with mogamulizumab was initiated. A total of 8 courses of mogamulizumab were administered, which resulted in CR. The rash and cutaneous nodular masses recurred again in January 2014, and a total of 8 courses of mogamulizumab were administered again starting in February 2014. However, the patient's symptoms began to worsen gradually. Phototherapy was also initiated, but had to be discontinued due to the development of photosensitivity. Treatment with the combination of mogamulizumab and etoposide (25 mg/day for 21 days) was started in May 2014. The nodular mass rapidly decreased in size. The rash or cutaneous nodular mass had not recurred as of August 2014. Thus, combined therapy with mogamulizumab plus etoposide is considered to be effective for resolution of the cutaneous nodular masses in patients with ATLL.
一名70岁男性因全身皮疹和右锁骨区肿块为主诉前来就诊，他于2012年首次发现这些症状。2013年3月，对肿块进行活检后诊断为皮肤结节型成人T细胞白血病/淋巴瘤（ATLL）。开始进行光疗，症状暂时有所改善。然而，2013年6月下旬，血清乳酸脱氢酶（LDH）水平升至358 IU/L，比参考范围上限高1.6倍；根据这些结果，诊断疾病已转化为急性型。患者接受了6个疗程的CHOP疗法（环磷酰胺、阿霉素、长春新碱和泼尼松龙），实现了完全缓解（CR）。然而，皮疹于2013年10月下旬复发，随后开始使用莫加莫拉单抗进行治疗。共给予8个疗程的莫加莫拉单抗，实现了CR。皮疹和皮肤结节肿块于2014年1月再次复发，从2014年2月开始再次给予共8个疗程的莫加莫拉单抗。然而，患者的症状开始逐渐恶化。也开始进行光疗，但由于出现光敏反应而不得不停止。2014年5月开始使用莫加莫拉单抗和依托泊苷联合治疗（25 mg/天，共21天）。结节肿块大小迅速减小。截至2014年8月，皮疹或皮肤结节肿块未再复发。因此，莫加莫拉单抗加依托泊苷联合疗法被认为对ATLL患者皮肤结节肿块的消退有效。
