Abstract
A 82-year-old man presented with an enlarged multiple superficial lymph nodes. The histological diagnosis of lymph node was peripheral T cell lymphoma, not otherwise specified (PTCL-NOS), with an aberrant expression of CD20. Generally, PTCL lacks B cell antigen such as CD19 or CD20, however, rare cases have been reported in the literature that showed PTCL patients expressing the B cell antigens. It is considered that the prognosis of CD20 positive PTCL is poor, however, standard therapy has not been established. He was treated with eight cycles of CHOP regimen, but the enlargement of a part of lymph nodes still remained. Recently, it is reported that C-C Chemokine receptor type 4 (CCR4) is known to be expressed about 50% case of PTCL and CCR4 target therapy is effective. Our case was positive for CCR4 so mogamulizumab (anti-CCR4 antibody) was administered. Consequently, dramatic response was obtained and its combination of these therapy resulted in complete remission for 24 months. This is the first case of sustained remission by administration of mogamulizumab against CCR4/CD20 double positive PTCL. This strategy may be benefit to obtain the good prognosis.
Highlights
PTCL is a kind of T cell malignancy which is generally originated from mature helper T cell/killer T cell and lack B cell lineage [1]
CD4/8 double negativity is occasionally seen [3]. Cytotoxic granule such as TIA-1 (T cell intracellular antigen-1) and granzyme B are exocytosed during specific interaction with target cells and CD8 positive cytotoxic T cells [4]. These granules are detected in anaplastic large cell lymphoma and extranodal NK/T-cell lymphoma, rarely detected in PTCL-NOS or adult T cell leukemia/lymphoma (ATLL)
Cytotoxic molecule expression in PTCL-U is considered to be a significant prognostic factor, independent from other clinical factors or prognostic index scores. These criteria suggested that our patient had worse prognosis. Conventional chemotherapy such as CHOP or CHOP like regimen has remained as standard therapy for PTCL since 1970s, but it has not led to an adequate prolongation of prognosis [5] [6]
Summary
PTCL is known to be a kind of T cell malignancy and lacks B cell antigen, rare cases have been reported in the literature that showed PTCL. It is considered that the prognosis of CD20 positive PTCL is poor, standard therapy has not been established. It is reported that CCR4 target therapy is effective for CCR4 positive PTCL. We present the first case of a successful combination chemotherapy followed by mogamulizumab treatment in peripheral T cell lymphoma with aberrant CD20 expression
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