Nagoya City West Medical Center Hematology and Oncology, Nagoya, Japan.
Department of Clinical Oncology, Nagoya Memorial Hospital, Nagoya, Japan.
Int J Hematol. 2021 Aug;114(2):280-285. doi: 10.1007/s12185-021-03135-5. Epub 2021 Mar 27.
Malignant lymphoma developing during anti-PD-1 antibody treatment is extremely rare. A 74-year-old female was admitted with left hypochondrial pain. She was diagnosed with squamous cell carcinoma of the right upper lobe of the lung, and had undergone surgery and postoperative chemotherapy three years prior. Needle biopsy of a mediastinal lymph node revealed recurrent lung cancer (LC). Pembrolizumab (PEM) monotherapy was started as salvage treatment. Although her lymphadenopathy improved, thrombocytopenia and splenomegaly developed during treatment with nine doses of PEM. Laboratory findings included anemia, increased lactate dehydrogenase, and soluble interleukin-2 receptor levels of 6379 U/mL. Flow cytometry of peripheral blood and bone marrow showed CD20, κ ≪ λ cell populations. IGH-BCL2 fusion was detected by fluorescence in situ hybridization in bone marrow. Positron emission tomography showed abnormal uptake in tonsils, both cervical lymph nodes, mediastinum (different location from the recurrent LC), spleen, and abdominal cavity. Follicular lymphoma (FL) grade 1/2 was histologically diagnosed by tonsillar biopsy. She achieved a complete metabolic response (CMR) after rituximab monotherapy on PEM discontinuation. Relapsed FL was diagnosed by submandibular gland biopsy four months after restarting PEM and she achieved a second CMR after rituximab-containing chemotherapy. We describe the first case of newly diagnosed FL during PEM treatment.
抗 PD-1 抗体治疗过程中发生的恶性淋巴瘤极为罕见。一名 74 岁女性因左侧季肋部疼痛入院。她被诊断为右肺上叶鳞状细胞癌，三年前曾接受手术和术后化疗。纵隔淋巴结针吸活检显示复发性肺癌（LC）。作为挽救治疗，开始使用 Pembrolizumab（PEM）单药治疗。尽管她的淋巴结病有所改善，但在接受九剂 PEM 治疗期间出现血小板减少症和脾肿大。实验室检查结果包括贫血、乳酸脱氢酶升高和可溶性白细胞介素 2 受体水平为 6379 U/mL。外周血和骨髓的流式细胞术显示 CD20、κ ≪ λ 细胞群。骨髓荧光原位杂交检测到 IGH-BCL2 融合。正电子发射断层扫描显示扁桃体、双侧颈部淋巴结、纵隔（与复发性 LC 不同部位）、脾脏和腹腔异常摄取。通过扁桃体活检组织学诊断为 1/2 级滤泡性淋巴瘤（FL）。在停止 PEM 后接受利妥昔单抗单药治疗后，她达到完全代谢缓解（CMR）。在重新开始 PEM 四个月后，行颌下腺活检诊断为复发性 FL，在接受含利妥昔单抗的化疗后她达到第二次 CMR。我们描述了首例在 PEM 治疗过程中发生的新诊断的 FL。
