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Pembrolizumab as a bridge to autologous stem cell transplantation in refractory gray zone lymphoma
Chun-Kuang Tsai1, Po-Shen Ko2, San-Chi Chen3
1 Division of Hematology, Department of Medicine, Taipei Veterans General Hospital; Faculty of Medicine, National Yang Ming Chiao Tung University; Division of Medical Oncology, Department of Oncology, Center for Immuno-Oncology, Taipei Veterans General Hospital; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
2 Division of Hematology, Department of Medicine, Taipei Veterans General Hospital; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
3 Faculty of Medicine, National Yang Ming Chiao Tung University; Division of Medical Oncology, Department of Oncology, Center for Immuno-Oncology, Taipei Veterans General Hospital; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
Correspondence Address:
Dr. San-Chi Chen
Division of Medical Oncology, Department of Oncology, Center for Immuno-oncology, Taipei Veterans General Hospital, Taipei, Taiwan, No. 201, Sec. 2, Shipai Road, Taipei 11217
Taiwan
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JCRP.JCRP_34_21
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Gray zone lymphoma (GZL), a rare type of B-cell lymphoma (BCL), has features between diffuse large BCL and classical Hodgkin lymphoma (cHL) and an unfavorable outcome. The expression of PD-L1, encoded by chromosome 9p24.1, has been positively correlated with the copy number alteration of 9p24.1, and it has been associated with a high response rate to anti-PD-1 treatment in cHL and primary mediastinal large BCL (PMBCL). GZL shares similar genomic alterations with cHL and PMBCL, and thus, it may also respond well to anti-PD-1 treatment. However, little is known about the efficacy of anti-PD-1 treatment and the predictive role of PD-L1 expression in GZL. Here, we present a case of GZL refractory to first-line chemotherapy. The patient had a high expression of PD-L1 and was successfully treated with pembrolizumab as a salvage treatment, followed by autologous stem cell transplantation (ASCT) in January 2018. The patient still had a complete metabolic response 42 months after ASCT.
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