Autoimmune disorders in patients with T-cell lymphoma: a comprehensive review

Bergh, Magali Van den; Alvarez-Argote, Juliana; Panwala, Amruta; Dasanu, Constantin A

doi:10.1185/03007995.2015.1074066

Cited by 7 publications

(5 citation statements)

References 67 publications

(24 reference statements)

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“…Concomitant autoimmune phenomena at time of diagnosis are observed in some PTCLs, most commonly in PTCLs with FH phenotype. (50) In our study, a wide spectrum of severe early irAEs, mostly occurring at sites uninvolved by TCL, were observed in both PTCL-FH and PTCL-NOS subtypes (Fig. 1).…”

Section: Discussionsupporting

confidence: 55%

Front-line Chemo-immunotherapy with Nivolumab and Dose-Adjusted (DA) EPOCH in Peripheral T-cell Lymphoma: A Phase I Trial

Haverkos,

Zain,

Kamdar

et al. 2023

Preprint

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Introduction:Dose-adjusted (DA)-EPOCH (etoposide, prednisone, vincristine, doxorubicin, and cyclophosphamide) is a frequently used first line chemotherapy regimen for peripheral T-cell lymphomas (PTCLs), but relapses are common and long-term outcomes are poor. Checkpoint blockade (CPB) immunotherapy has shown modest single agent efficacy in relapsed PTCLs. In other hematologic malignancies the combination of CPB and cytotoxic chemotherapy is promising. Methods: We conducted a Phase I trial to assess safety, spectrum of immune-related toxicity, and efficacy of nivolumab (Nivo) in combination with DA-EPOCH as front-line therapy for PTCLs. Patients received Nivo (360 mg) followed by DA-EPOCH every 21 days for six cycles. Patients were allowed to receive one cycle of standard-of-care chemotherapy prior to enrollment. Results:18 patients were enrolled: 7 PTCL-not otherwise specified (NOS), 6 nodal T-cell lymphomas with a T-follicular helper phenotype, 2 primary cutaneous gamma/delta T-cell lymphoma, 2 ALK negative anaplastic large cell lymphoma, and 1 subcutaneous panniculitis like T-cell lymphoma. Fifteen had an intermediate or high-risk International Prognostic Index. Immune related (ir) adverse events (AEs) of all grades occurred in 14 and 7 patients experienced ≥ grade 3 irAEs. Eight patients required discontinuation of Nivo due to irAEs. Of the 6 patients who received a cycle of anthracycline-based combination chemotherapy prior to enrollment, none experienced an irAE resulting in Nivo dose hold or discontinuation, compared to 8 of 12 patients whose first cycle was Nivo+DA-EPOCH. There were no hyperprogression events. Interim and end of therapy overall response rates were 94% and 89%, respectively (11 complete responses, 5 partial responses, and 2 progressive diseases). With a median follow up of 707 days, median progression free and overall survival is 434 and 714 days, respectively. Conclusions: Front-line Nivo + DA-EPOCH showed good feasibility and acceptable safety when Nivo was started after chemotherapy but was associated with frequent dose-limiting irAEs when administered synchronously. Efficacy was encouraging with lengthy responses in very high risk PTCL subtypes. Further investigation of front-line line CPB-chemotherapy combinations in PTCL is warranted using a sequential approach. The trial is registered with ClinicalTrials.gov, NCT 03586999.

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Section: Discussionsupporting

confidence: 55%

Front-line Chemo-immunotherapy with Nivolumab and Dose-Adjusted (DA) EPOCH in Peripheral T-cell Lymphoma: A Phase I Trial

Haverkos,

Zain,

Kamdar

et al. 2023

Preprint

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“…Patients with lymphoma appear to have an increased risk of various autoimmune conditions, both hematological and non-hematological[ 5 ]. Among them, AITL is often accompanied by various immunological and hematological diseases, such as autoimmune hemolytic anemia (AIHA), vasculitis, and autoimmune thyroid disease[ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with PRCA, cyclosporine A should be routinely prescribe, although we did not do so. Previous reports have suggested that PRCA associated with AITL is improved only with the treatment of AITL, which is chemotherapy[ 5 , 6 , 9 ]. Therefore, we started treatment with chemotherapy for AITL, but no direct treatment of PRCA.…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis remains uncertain because of the limited number of reported cases of PRCA with AITL[ 6 , 9 ], although it is reasonable to assume the possibility of multifactorial pathogenic involvement. Previous reports have suggested that AITL might trigger autoimmune alterations that lead to PRCA[ 5 ]. Another study demonstrated that malignant B-cell clones might produce autoreactive antibodies against erythroid progenitors, and neoplastic T-cells might directly or indirectly inhibit the erythroid differentiation of hematopoietic stem cells[ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Angioimmunoblastic T-cell lymphoma accompanied by pure red cell aplasia: A case report

Kawahigashi

Kitagawa

Tanaka

2020

WJCO

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BACKGROUND Angioimmunoblastic T-cell lymphoma (AITL) is a peripheral T-cell lymphoma, which is a rare subtype of lymphoma. Patients with AITL often have skin lesions, which are observed in 50% of all cases; the chief complaint of this patient was palpable purpura. AITL often complicates autoimmune or hematological disorders; however, among these, pure red cell aplasia (PRCA) is a very rare complication of AITL. We herein report a case of AITL with PRCA. CASE SUMMARY A 77-year-old Japanese man presented to our hospital with complaints of loss of appetite for 2 mo and a 10-d history of palpable purpura. On physical examination, the patient was afebrile but had bilateral multiple palpable purpuric lesions over the lower extremities, lower abdomen, and part of the upper extremities. Moreover, lymphadenopathy of the bilateral inguinal, cervical, and supraclavicular nodes was noted. Laboratory and imaging studies and skin biopsy were conducted but were inconclusive. Based on inguinal lymph node excisional biopsy, we diagnosed the patient with AITL. Subsequently, the patient developed progressive normocytic normochromic anemia that necessitated almost daily blood transfusion. The clinical presentations and results of bone marrow assessment were consistent with those of PRCA, which is associated with AITL. Chemotherapy was initiated but was not effective. The patient refused further chemotherapy and opted to continue receiving best supportive care. CONCLUSION PRCA is an extremely rare complication of AITL. As the pathophysiology remains unclear, further research is warranted.

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“…NOTCH1 and NOTCH3 receptors have been reported to play a role in T-cell lymphoma development in patients with celiac disease. 27 Because only a few T-cell lymphomas have been found in patients with autoimmune diseases, 28 more cases are needed to understand the epidemiology, clinical and immunophenotypic features, and underlying mechanisms of T-cell lymphoma development in patients with autoimmune disorders.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and outcome of lymphoma patients with pre‐existing autoimmune diseases

et al. 2017

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Aims: Previous epidemiological studies have shown that autoimmune diseases increase the risk of lymphoma development. However, whether autoimmune diseases deteriorate the outcomes for lymphoma patients remains unclear. This study aimed to identify the clinical features of lymphoma patients with pre-existing autoimmune diseases. Whether pre-existing autoimmune diseases impacted progression-free survival (PFS) and overall survival (OS) in lymphoma patients was further investigated. Methods:We retrospectively reviewed medical records of 913 newly diagnosed lymphoma patients from January 2008 to November 2016. Thirty-four lymphoma patients with pre-existing autoimmune disorders were identified. Six of these 34 patients were lost to follow-up; their data was used to examine baseline clinical characteristics but not survival. Therefore, 28 lymphoma patients with autoimmune diseases were included in the autoimmune disease group for comparing the remission rate, PFS and OS to lymphoma patients without autoimmune diseases (control group; n = 56).Results: Diffuse large B-cell lymphoma was the most common histological subtype (18/34; 52.94%). Complete remission rates in the autoimmune disease and control groups were 72.0% and 83.3%, respectively (P = 0.178). Patients with and without autoimmune diseases had similar PFS (45.4 AE 59.9 months vs. 51.5 AE 42.8 months; P = 0.398) and OS (46.4 AE 52.6 months vs. 50.1 AE 47.3 months; P = 0.352). By univariate analysis, pre-existing autoimmune diseases were not associated with inferior PFS (P = 0.326) or OS (P = 0.627).Conclusions: Lymphoma patients with and without autoimmune disorders had comparable outcomes. Autoimmune diseases are not an obstacle to lymphoma treatment.

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Autoimmune disorders in patients with T-cell lymphoma: a comprehensive review

Cited by 7 publications

References 67 publications

Front-line Chemo-immunotherapy with Nivolumab and Dose-Adjusted (DA) EPOCH in Peripheral T-cell Lymphoma: A Phase I Trial

Front-line Chemo-immunotherapy with Nivolumab and Dose-Adjusted (DA) EPOCH in Peripheral T-cell Lymphoma: A Phase I Trial

Angioimmunoblastic T-cell lymphoma accompanied by pure red cell aplasia: A case report

Clinical features and outcome of lymphoma patients with pre‐existing autoimmune diseases

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