Successful Treatment of a Patient with Brentuximab Vedotin-Refractory ALK-Negative Anaplastic Large Cell Lymphoma with Romidepsin

Abstract

We present the case of a 78-year-old male patient who was diagnosed with anaplastic lymphoma kinase (ALK)-negative, CC chemokine receptor 4 (CCR4)-negative, and CD30-positive anaplastic large cell lymphoma (ALCL). The patient had a past medical history of adult T-cell leukemia/lymphoma and colon cancers that had developed simultaneously approximately 2 years prior to the development of ALCL that were treated with immunochemotherapy and resection, respectively. Initial treatment for ALCL included brentuximab vedotin, an anti-CD30 monoclonal antibody-monomethyl auristatin E conjugate; however, we were unable to achieve a sufficient treatment effect. Romidepsin, an oral histone deacetylase inhibitor, was introduced as salvage chemotherapy; complete remission was attained. Interestingly, a reversal of the CD4/CD8 ratio and a reduction in human T-lymphotropic virus type 1 (HTLV-1) virus load was observed after 2 cycles of immunochemotherapy; the patient experienced upregulation of HTLV-1 Tax-specific cytotoxic T lymphocytes after a herpes zoster infection and the completion of immunotherapy. The immunologic status was maintained from the time of diagnosis through the completion of romidepsin therapy. Our findings indicate that romidepsin can be used safely and effectively to treat ALCL without impairing cellular immunity to HTLV-1.

HTLV‐1 Tax‐specific memory cytotoxic T lymphocytes in long‐term survivors of aggressive‐type adult T‐cell leukemia/lymphoma

“…Fortunately, the patient achieved CR for ALCL through treatment with romidepsin. The Tax‐specific CTLs were maintained at high percentages during the romidepsin therapy and until the last follow‐up without any relapse of ATLL and ALCL in this patient 41 . These results suggest that mogamulizumab alone is insufficient to induce adequate Tax‐specific CTLs production.…”

“…The Tax‐specific CTLs were maintained at high percentages during the romidepsin therapy and until the last follow‐up without any relapse of ATLL and ALCL in this patient. 41 These results suggest that mogamulizumab alone is insufficient to induce adequate Tax‐specific CTLs production. Herpes virus infection has been reported to activate innate and adaptive immune responses, which include the release of inflammatory cytokines and chemokines.…”

Inhibition of histone deacetylases attenuates tumor progression and improves immunotherapy in breast cancer

“…Moreover, Romidepsin-mediated tumor suppression was abrogated by anti-PD-1 antibody treatment in colon cancer cells ( 61 ). One case report showed that romidepsin might be safe and effective for treatment of anaplastic large cell lymphoma (ALCL), which did not impair cellular immunity to HTLV-1 ( 62 ).…”