Combined immune checkpoint blockade and radiotherapy induces durable remission in relapsed natural killer/T-cell lymphoma: a case report and review of the literature

Elizabeth McGehee, Hetalkumari Patel, Caroline Pearson, Keri Clements, Jesse Manuel Jaso, Weina Chen, Alexandra Callan, Neil Desai, Praveen Ramakrishnan Geethakumari

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Extranodal natural killer/T-cell lymphoma is a rare, aggressive non-Hodgkin lymphoma that is treated upfront mostly with L-asparaginase containing regimens. Relapsed extranodal natural killer/T-cell lymphoma is associated with a poor prognosis, and there is no established standard of care. Case presentation: We report the case of a 72 year-old white male with a distant extranasal relapse of extranodal natural killer/T-cell lymphoma that has been managed successfully with a combination of radiation and immune checkpoint blockade with pembrolizumab. Pseudoprogression with new skin and bone lesions on positron emission tomography imaging was encountered during this Caucasian patient’s immunotherapy and was successfully managed with supportive care and continuation of immune checkpoint blockade. Conclusions: The patient has been in complete clinical, radiologic, and molecular remission for close to 3 years and has not had any immune-related adverse effects. Pseudoprogression is a clinical challenge that can be encountered while patients are treated with immunotherapy, and astute clinical acumen is needed for accurate management. We believe this is the longest duration of response to immune checkpoint blockade in relapsed extranodal natural killer/T-cell lymphoma reported to date in literature. There is a strong biologic rationale in combining radiation with immunotherapy. The optimal timing, dose, and duration of radiation combined with immunotherapy in extranodal natural killer/T-cell lymphoma need to be prospectively evaluated.

Original languageEnglish (US)
Article number221
JournalJournal of Medical Case Reports
Volume15
Issue number1
DOIs
StatePublished - Dec 2021

Keywords

  • Extranodal NK/T-cell lymphoma (ENKL)
  • Immune checkpoint blockade
  • PD-1
  • PD-L1
  • Pseudoprogression
  • Radiation therapy

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint

Dive into the research topics of 'Combined immune checkpoint blockade and radiotherapy induces durable remission in relapsed natural killer/T-cell lymphoma: a case report and review of the literature'. Together they form a unique fingerprint.

Cite this