Abstract
Anaplastic large cell lymphoma (ALCL) with ALK-translocation constitutes an aggressive lymphoma with high sensitivity to anthracycline-based chemotherapy. Relapse, however, is observed in about one-third of patients. Salvage treatment incorporates high-dose chemotherapy followed by autologous or allogeneic stem cell transplantation, treatment with the CD30-specific immunoconjugate Brentuximab vedotin (BV) and the use of ALK-inhibitors, such as crizotinib. In this case report, we present a patient with a rare late relapse of ALK-positive ALCL following chemotherapy, who was neither eligible for high-dose chemotherapy nor treatment with BV. Relapse therapy was carried out with daily crizotinib, which rapidly mediated complete regression of all ALCL manifestations. In light of few clinical trials published on the use of crizotinib against ALCL, we want to further substantiate the efficacy of crizotinib as salvage therapy in patients with relapsed ALCL especially if ineligible for high-dose chemotherapy or BV treatment. Finally, we would like to enhance vigilance for potential late relapse of ALCL more than a decade after frontline treatment.
Highlights
Anaplastic large cell lymphoma (ALCL) is a rare hematological neoplasia representing only two percent of all non-Hodgkin’s lymphomas [1]
We present a patient with a rare late relapse of anaplastic lymphoma kinase (ALK)-positive ALCL following anthracycline-based chemotherapy, who entered ongoing complete remission after initiation of treatment with crizotinib
computed tomography (CT)-guided biopsy of a hypermetabolic lesion located in the eighth rib of the left hemithorax revealed a relapse of the previously known ALK-positive ALCL nearly 14 years after chemotherapy
Summary
Anaplastic large cell lymphoma (ALCL) is a rare hematological neoplasia representing only two percent of all non-Hodgkin’s lymphomas [1]. Given the paucity of clinical trials evaluating the efficacy of crizotinib in adult ALCL patients, clinical evidence and practical advice regarding the use of crizotinib in adult ALCL patients is still significantly sourced from a steadily growing number of case reports In this case report, we present a patient with a rare late relapse of ALK-positive ALCL following anthracycline-based chemotherapy, who entered ongoing complete remission after initiation of treatment with crizotinib. After eight cycles of chemotherapy, the patient entered into a complete remission without residual ALCL presence visible on CT-imaging and bone marrow examination. CT-guided biopsy of a hypermetabolic lesion located in the eighth rib of the left hemithorax revealed a relapse of the previously known ALK-positive ALCL nearly 14 years after chemotherapy.
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