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Complete response following toxic epidermal necrolysis in relapsed adult T cell leukemia/lymphoma after haploidentical stem cell transplantation

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Abstract

Allogeneic hematopoietic cell transplantation (allo-HSCT) is considered the curative treatment option in patients with aggressive adult T cell leukemia/lymphoma (ATLL), but the treatment of relapse after allo-HSCT remains a major challenge. We report a case of ATLL that was treated with sequential mogamulizumab (MOG) and lenalidomide (LEN) for early relapse after allo-HSCT. A 73-year-old Japanese male with acute-type ATLL underwent haploidentical-HSCT with post-transplant cyclophosphamide. He attained a complete response. However, ATLL relapse was diagnosed by biopsy of skin lesions that appeared on day 67. Discontinuation of immunosuppressant therapy alone did not result in improvement of ATLL, however, the skin lesions disappeared after an immune response was induced by sequential MOG and LEN. Following MOG and LEN, very serious toxic epidermal necrolysis (TEN) developed requiring high-dose intravenous immunoglobulin and methylprednisolone pulse therapy. Although graft-versus-host disease exacerbated and progressed to TEN, a complete response was achieved after successful treatment of TEN. These agents may thus enhance anti-ATLL activity by immune modulation. Further investigation is necessary to determine the optimal use of MOG and LEN in relapsed ATLL after allo-HSCT.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan

    Satoshi Morishige, Yoshitaka Yamasaki, Shuki Oya, Takayuki Nakamura, Ritsuko Seki, Maki Yamaguchi, Kazutoshi Aoyama, Fumihiko Mouri, Koichi Osaki & Koji Nagafuji

  2. Department of Dermatology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan

    Marina Nishi & Hiroshi Saruta

  3. Department of Pathology, School of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan

    Fumiko Arakawa & Koichi Ohshima

Authors
  1. Satoshi Morishige
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  2. Marina Nishi
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  3. Hiroshi Saruta
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  4. Fumiko Arakawa
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  11. Fumihiko Mouri
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  13. Koichi Ohshima
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  14. Koji Nagafuji
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Correspondence to Koji Nagafuji.

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Morishige, S., Nishi, M., Saruta, H. et al. Complete response following toxic epidermal necrolysis in relapsed adult T cell leukemia/lymphoma after haploidentical stem cell transplantation. Int J Hematol 110, 506–511 (2019). https://doi.org/10.1007/s12185-019-02675-1

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  • DOI: https://doi.org/10.1007/s12185-019-02675-1

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