McGehee Elizabeth, Patel Hetalkumari, Pearson Caroline, Clements Keri, Jaso Jesse Manuel, Chen Weina, Callan Alexandra, Desai Neil, Ramakrishnan Geethakumari Praveen
Division of Hematologic Malignancies and Stem Cell Transplantation, Harold. C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
Department of Hemato-Pathology, Harold. C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
J Med Case Rep. 2021 Apr 30;15(1):221. doi: 10.1186/s13256-021-02798-2.
Extranodal natural killer/T-cell lymphoma is a rare, aggressive non-Hodgkin lymphoma that is treated upfront mostly with L-asparaginase containing regimens. Relapsed extranodal natural killer/T-cell lymphoma is associated with a poor prognosis, and there is no established standard of care.
We report the case of a 72 year-old white male with a distant extranasal relapse of extranodal natural killer/T-cell lymphoma that has been managed successfully with a combination of radiation and immune checkpoint blockade with pembrolizumab. Pseudoprogression with new skin and bone lesions on positron emission tomography imaging was encountered during this Caucasian patient's immunotherapy and was successfully managed with supportive care and continuation of immune checkpoint blockade.
The patient has been in complete clinical, radiologic, and molecular remission for close to 3 years and has not had any immune-related adverse effects. Pseudoprogression is a clinical challenge that can be encountered while patients are treated with immunotherapy, and astute clinical acumen is needed for accurate management. We believe this is the longest duration of response to immune checkpoint blockade in relapsed extranodal natural killer/T-cell lymphoma reported to date in literature. There is a strong biologic rationale in combining radiation with immunotherapy. The optimal timing, dose, and duration of radiation combined with immunotherapy in extranodal natural killer/T-cell lymphoma need to be prospectively evaluated.
结外自然杀伤/T细胞淋巴瘤是一种罕见的侵袭性非霍奇金淋巴瘤，初始治疗大多采用含L-天冬酰胺酶的方案。复发的结外自然杀伤/T细胞淋巴瘤预后较差，且尚无既定的标准治疗方案。
我们报告了一例72岁白人男性患者，其结外自然杀伤/T细胞淋巴瘤出现鼻外远处复发，通过放疗和帕博利珠单抗免疫检查点阻断联合治疗成功控制。该白人患者在免疫治疗期间正电子发射断层扫描成像出现新的皮肤和骨病变的假性进展，通过支持治疗和继续免疫检查点阻断成功处理。
该患者已实现接近3年的完全临床、影像学和分子缓解，且未出现任何免疫相关不良反应。假性进展是免疫治疗患者可能遇到的临床挑战，准确处理需要敏锐的临床洞察力。我们认为这是文献报道中复发结外自然杀伤/T细胞淋巴瘤对免疫检查点阻断反应持续时间最长的。放疗与免疫治疗联合有很强的生物学依据。结外自然杀伤/T细胞淋巴瘤中放疗与免疫治疗联合的最佳时机、剂量和持续时间需要前瞻性评估。
