Risk stratification of patients with relapsed and refractory follicular lymphoma (FL) remains challenging. Recently, much attention has been paid to the impact of early progression of disease within 2 years of diagnosis (early POD) on subsequent survival. The aim of this study was to clarify the clinical features and prognostic factors of patients with FL who experienced early POD. Data were available for 94 patients diagnosed with FL (clinical stage II-IV) who had received immunochemotherapy. Early POD was seen in 20 % of these patients. The Cox proportional hazards model showed worse overall survival (OS) in the patients with early POD compared with those without early POD (5-year OS rates 48 % vs. 96 %, P < 0.0001). In multivariate analysis, early POD (P = 0.003) and poor performance status (P = 0.006) remained a significant factor for subsequent OS. In Follicular Lymphoma International Prognostic Index (FLIPI)- and Follicular Lymphoma International Prognostic Index-2 (FLIPI2)-adjusted Cox regression analysis, early POD was associated with markedly reduced OS with a hazard ratio of 11.2 [95 % confidence interval (CI) 3.13-40.3, P < 0.001] and 13.5 (95 % CI 3.22-56.3, P < 0.003), respectively. Among patients who had early POD, high levels of serum lactate dehydrogenase (LDH) both at the time of initial diagnosis and first progression could be associated with worse survival (2-year OS rates 33 vs. 92 %, P < 0.0001). Evaluation of LDH levels at the time of initial diagnosis and first progression may be important to define patients who were associated with worse prognosis. Risk stratification of patients with early POD could lead to improved clinical outcomes for FL patients. Further research is needed to investigate its value for decision making.
There are few effective options for salvage therapy in elderly patients with relapsed or refractory angioimmunoblastic T-cell lymphoma (AITL). The anti-CCR4 antibody mogamulizumab works via antibody-dependent cytotoxic activity, reduces regulatory T cells, and evokes antitumor immunity in cancer patients. We report a 78-year-old patient with refractory AITL receiving a new immunochemotherapy consisting of sequential mogamulizumab administration followed by the GDP (gemcitabine, dexamethasone and cisplatin) regimen. A favorable consolidative effect of the GDP regimen could be observed in the patient who had partial remission after administration of mogamulizumab monotherapy. The regimen showed an acceptable toxicity profile without serious autoimmunity and an expected treatment response for the elderly patient with primary refractory AITL. This clinical case is the first report of salvage chemotherapy including mogamulizumab for primary refractory AITL described in the literature.
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