Epstein–Barr virus-related diffuse large B-cell lymphoma in mogamulizumab-treated adult T-cell leukemia with incomplete T-cell reconstitution

Adult T-cell leukemia (ATL) is an aggressive mature T-cell malignancy with a poor prognosis. The anti-C–C motif chemokine receptor 4 (CCR4) antibody mogamulizumab (moga) reduces ATL cells and induces reconstitution of polyclonal T cells; however, ATL cases often remain resistant and moga sometimes c...

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Bibliographic Details
Published in:International journal of hematology 2019-02, Vol.109 (2), p.221-227
Main Authors: Kamachi, Kazuharu, Shindo, Takero, Miyahara, Masaharu, Kitaura, Kazutaka, Akashi, Michiaki, Shin-I, Tadasu, Suzuki, Ryuji, Oshima, Koichi, Kimura, Shinya
Format: Article
Language:English
Subjects:
Antibodies
B-cell lymphoma
Case Report
Central nervous system
Chemokine receptors
Chemotherapy
Epstein-Barr virus
Hematology
Immunity
Immunotherapy
Leukemia
Lymphocytes
Lymphocytes B
Lymphocytes T
Lymphoma
Malignancy
Medicine
Medicine & Public Health
Next-generation sequencing
Oncology
Sequences
Skin
T cell receptors
Targeted cancer therapy
Viruses
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Summary:Adult T-cell leukemia (ATL) is an aggressive mature T-cell malignancy with a poor prognosis. The anti-C–C motif chemokine receptor 4 (CCR4) antibody mogamulizumab (moga) reduces ATL cells and induces reconstitution of polyclonal T cells; however, ATL cases often remain resistant and moga sometimes causes fatal immunopathology. Epstein–Barr virus (EBV)-related B-cell lymphoma develops in severely immunocompromised subjects, and is particularly associated with impaired T-cell immunity. Here, we report an ATL patient who had received conventional chemotherapy plus moga, and subsequently developed EBV-related diffuse large B-cell lymphoma (DLBCL) of the central nervous system. Next-generation sequencing-based T-cell receptor repertoire analyses identified residual abnormal clones and revealed that reconstitution of polyclonal T cells was incomplete, even after moga treatment. Furthermore, a skin rash that developed after moga treatment was found to contain ATL clones. This case suggests that the limited therapeutic effects of moga and incomplete T-cell reconstitution are associated with severely impaired T-cell immunity and subsequent development of EBV-related DLBCL.
ISSN:0925-5710
1865-3774
DOI:10.1007/s12185-018-2552-x