The histological spectrum of talimogene laherparepvec (TVEC) injections—Neutrophilic and chronic granulomatous dermatitis

Lee, Katrina; Pouldar, Delila; Shiu, Jessica; Elsensohn, Ashley; Feraudy, Sébastien de

doi:10.1111/cup.13387

Cited by 6 publications

(6 citation statements)

References 3 publications

(5 reference statements)

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“…4 Neutrophilic dermatitis, lymphocytic dermatitis, interface dermatitis, extensive pigment incontinence mimicking melanoma, and panniculitis have also been described. [2][3][4][6][7][8][9][10] In the case of the interstitial lymphocytic dermatitis and panniculitis, the patient's symptoms resolved following the removal of TVEC. 3,4 To the best of our knowledge, pseudolymphomatous reaction in response to TVEC administration has not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

“…Other skin reactions such as pruritus, vitiligo, and erysipelas have also been reported following TVEC therapy 4 . Neutrophilic dermatitis, lymphocytic dermatitis, interface dermatitis, extensive pigment incontinence mimicking melanoma, and panniculitis have also been described 2‐4,6‐10 . In the case of the interstitial lymphocytic dermatitis and panniculitis, the patient's symptoms resolved following the removal of TVEC 3,4 …”

Section: Discussionmentioning

confidence: 99%

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Talimogene laherparepvec pseudolymphomatous reaction mimicking metastatic melanoma

2021

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Talimogene laherparepvec (TVEC) is a genetically modified herpes simplex virus-1 approved as an intralesional oncolytic immunotherapy for the treatment of advanced melanoma. Cutaneous reactions at the site of injection may mimic recurrent or progressive melanoma; histopathological findings have included chronic granulomatous dermatitis, neutrophilic dermatitis, lymphocytic dermatitis, and pigment incontinence. We report a 39-year-old male with metastatic stage IIIc melanoma treated with TVEC with clinical regression of melanoma lesions that later developed pink nodules at sites of prior injection. Histopathology demonstrated a nodular mononuclear infiltrate that stained strongly and diffusely with CD45 and CD20 with a surrounding rim of CD3-positive T-cells. Immunoglobulin gene rearrangement was negative for a clonal B-cell population. To our knowledge, this is the first report of a pseudolymphomatous reaction mimicking recurrent melanoma after TVEC therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Talimogene laherparepvec pseudolymphomatous reaction mimicking metastatic melanoma

2021

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“…Development of granulomatous inflammation after T-VEC therapy is reported in only 3 other instances in the literature (Table 1). [1][2][3] The mechanism is likely mediated by the presence of virus from local T-VEC injection, along with an enhanced macrophage response from GM-CSF production. HSVI/II stains that were performed in our case were negative.…”

Section: Tumoral Melanosis and Separate Granulomatous Inflammation Du...mentioning

confidence: 99%

“…We read with great interest the case series by Everett et al 1 and Lee et al 2 describing the development of chronic granulomatous inflammation after treatment with talimogene laherparepvec (T-VEC) for advanced melanoma. We present an additional case of tumoral melanosis with extensive surrounding granulomatous inflammation developing after T-VEC injections, and provide a review of all reported cases to date from the available literature.…”

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confidence: 99%

Tumoral Melanosis and Separate Granulomatous Inflammation due to Talimogene Laherparepvec

Shwe

Yamamoto²,

Linden³

et al. 2022

The American Journal of Dermatopathology

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“…[19] also described the presence of plasma cells in the first histopathological case series of patients treated with T-VEC ( n = 5), but mainly focused on the presence of granulomas, as did Lee et al . [20] ( n = 3). Therefore, it is unclear how often this plasmacellular/B cell/humoral response is present and so far analysis of a large series of the histopathological spectrum of T-VEC is lacking.…”

Section: Introductionmentioning

confidence: 99%

Histopathological and immunological spectrum in response evaluation of talimogene laherparepvec treatment and correlation with durable response in patients with cutaneous melanoma

Mulder

Damman²,

Verver

et al. 2022

Melanoma Research

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Talimogene laherparepvec (T-VEC) is an intralesional oncolytic virotherapy for patients with irresectable stage III–IVM1a cutaneous melanoma. Although this treatment is considered to mainly act through T cell-mediated mechanisms, prominent numbers of plasma cells after T-VEC treatment have been described. The aim was to investigate how often these plasma cells were present, whether they were relevant in the response to treatment, and if these or other histopathological features were associated with durable response to treatment. Histopathological (granulomas, perineural inflammation, etc.) and immunological features [e.g. B cells/plasma cells (CD20/CD138) and T cells (CD3,CD4,CD8)] were scored and correlated with durable tumor response [i.e. complete response (CR) persisting beyond 6 months after treatment]. Plasmacellular infiltrate was examined with next-generation sequencing and immunohistochemistry (IgG, IgM, IgA, and IgD). Plasma cells were present in all T-VEC injected biopsies from 25 patients with melanoma taken at 3–5 months after starting treatment. In patients with a durable response (n = 12), angiocentric features and granulomas were more frequently identified compared with patients without a (durable) response (n = 13); 75% versus 29% for angiocentric features (P = 0.015) and 58% versus 15% for granulomas (P = 0.041). There was a class switch of IgM to IgG with skewing to certain dominant Ig heavy chain clonotypes. An angiocentric granulomatous pattern in T-VEC injected melanoma lesions was associated with a durable CR (>6 months). Plasma cells are probably a relevant feature in the mechanism of response but were not associated with durable response.

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The histological spectrum of talimogene laherparepvec (TVEC) injections—Neutrophilic and chronic granulomatous dermatitis

Cited by 6 publications

References 3 publications

Talimogene laherparepvec pseudolymphomatous reaction mimicking metastatic melanoma

Talimogene laherparepvec pseudolymphomatous reaction mimicking metastatic melanoma

Tumoral Melanosis and Separate Granulomatous Inflammation due to Talimogene Laherparepvec

Histopathological and immunological spectrum in response evaluation of talimogene laherparepvec treatment and correlation with durable response in patients with cutaneous melanoma

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