Extra-Nodal, Nasal, Natural Killer T-Cell Lymphoma Treated With a Checkpoint Inhibitor: A Case Report of a Sustained Complete Response

Use of PD-1 blockade in refractory/relapsed natural killer T-cell lymphomas: a systematic review and synthesis of case reports

Natural killer/T-cell lymphoma (NK/T-cellL) is an aggressive non-Hodgkin's lymphoma with limited treatment options for patients who experience disease progression or recurrence after second-line treatment. The use of new therapies, such as pembrolizumab, which involves immune checkpoint blockade mechanisms, is proposed. This systematic review followed the MOSE guidelines and searched PUBMED/MEDLINE, EMBASE, and Scopus databases. Fourteen articles were found, reporting on the use of pembrolizumab anti PD-1 in NK/T-cellL patients. The objective response rate was 84.50%, with disease-free survival ranging from two to 48 months. The complete response rate was 61.6%, and the quality of the reported studies was evaluated to be of high and moderate confidence bias levels in case reports and high bias in clinical trials. Pembrolizumab and others anti PD-1 are treatment options for refractory/recurrent NK/T-cellL, regardless of PD-L1 expression, with good short- and long-term results and low adverse events.

Combination of atezolizumab and chidamide to maintain long-term remission in refractory metastatic extranodal natural killer/T-cell lymphoma: A case report

BACKGROUND

The prognosis of refractory extranodal natural killer/T-cell lymphoma (ENKTL) is poor. Recent data have indicated that immune checkpoint blockade with a programmed cell death protein-1 (PD-1) antibody in combination with administration of histone deacetylase inhibitors represents a potentially effective treatment strategy. Compared with PD-1 antibodies, programmed death-ligand 1 antibodies have fewer side effects. Here, we present a rare case of a patient with refractory metastatic ENKTL who achieved sustained remission of approximately 10 mo with minor adverse effects after combination therapy with atezolizumab, chidamide, and radiotherapy.

CASE SUMMARY

A 56-year-old woman underwent resection of a tumour in her left nasal cavity and was diagnosed with ENKTL (nasal type). Medical examination revealed tumours observed in the bilateral nasal mucosa, the subcutaneous soft tissue of the inner side of the left eye, the soft tissue of the nasopharynx, the bilateral tonsils, and the left preauricular, right hilar, bilateral neck lymph nodes and bone marrow. However, tomography/computed tomography showed increased metabolism of the bilateral nasal mucosa and subcutaneous soft tissue of the inner side of the left eye and newly increased metabolism of the left cervical lymph node after chemotherapy. Therefore, combination therapy with chidamide, atezolizumab, and radiotherapy was performed. Fortunately, the patient achieved a complete response following 10 mo of combination therapy.

CONCLUSION

The outcome in this case suggests that the combination of atezolizumab, chidamide, and radiotherapy is a promising regimen for treating refractory metastatic ENKTL following chemotherapy treatment failure.