Persistent complete remission of acute leukemic-phase CCR4-positive gamma-delta peripheral T-cell lymphoma by autologous stem cell transplantation with mogamulizumab

Int J Hematol. 2015 Oct;102(4):498-505. doi: 10.1007/s12185-015-1805-1. Epub 2015 May 15.

Abstract

Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), frequently shows a poor outcome. Especially, expressions of CC chemokine receptor 4 (CCR4) and γδ T-cell receptor (TCR) are associated with worse prognosis in PTCL-NOS. We here report successful treatment with autologous peripheral blood stem cell transplantation (auto-PBSCT) combined with anti-CCR4 antibody mogamulizumab for a very rare case of CCR4+γδTCR+ PTCL-NOS that coexisted with Hodgkin's lymphoma. PTCL-NOS in this patient progressed to leukemic phase, whereas Hodgkin's lymphoma disappeared with standard chemotherapies within 4 years of the initial diagnosis. Leukemic-phase PTCL-NOS was refractory to several chemotherapies. However, auto-PBSCT following high-dose chemotherapy combined with pre- and post-transplant mogamulizumab, which is a humanized monoclonal antibody to CCR4, provided persistent complete remission of PTCL-NOS, despite residual γδTCR+ in the transplanted stem cell product, suggesting a purging effect of mogamulizumab. At 15 months after transplantation, we also found markedly fewer effector regulatory T cells, which may have contributed to prolonged remission. This case suggests that autologous stem cell transplantation combined with mogamulizumab may have a potential to cure T-cell neoplasms that express CCR4 including leukemic-phase PTCL-NOS.

Keywords: Autologous stem cell transplantation; CCR4; Mogamulizumab; Peripheral T-cell lymphoma not otherwise specified; Purging.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Autografts
  • Humans
  • Male
  • Middle Aged
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma* / blood
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma* / therapy
  • Receptors, Antigen, T-Cell, gamma-delta / blood*
  • Receptors, CCR4 / antagonists & inhibitors*
  • Receptors, CCR4 / blood
  • Remission Induction
  • Stem Cell Transplantation*

Substances

  • Antibodies, Monoclonal, Humanized
  • CCR4 protein, human
  • Receptors, Antigen, T-Cell, gamma-delta
  • Receptors, CCR4
  • mogamulizumab