Mogamulizumab投与後に移植後大量cyclophosphamideを用いてHLA半合致移植を施行した成人T細胞リンパ腫  [in Japanese] Haploidentical transplantation using post-transplant high-dose cyclophosphamide for adult T-cell lymphoma after mogamulizumab treatment  [in Japanese]

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Author(s)

    • 千葉 滋 CHIBA Shigeru
    • 筑波大学附属病院 血液内科|筑波大学医学医療系 血液内科 Department of Hematology, University of Tsukuba Hospital|Department of Hematology, Faculty of Medicine, University of Tsukuba
    • 栗田 尚樹 KURITA Naoki
    • 筑波大学附属病院 血液内科|筑波大学医学医療系 血液内科 Department of Hematology, University of Tsukuba Hospital|Department of Hematology, Faculty of Medicine, University of Tsukuba
    • 錦井 秀和 NISHIKII Hidekazu
    • 筑波大学附属病院 血液内科|筑波大学医学医療系 血液内科 Department of Hematology, University of Tsukuba Hospital|Department of Hematology, Faculty of Medicine, University of Tsukuba
    • 佐藤 利栄 SATO Rie
    • 筑波大学附属病院 血液内科 Department of Hematology, University of Tsukuba Hospital
    • 吉田 近思 YOSHIDA Chikashi
    • 独立行政法人国立病院機構水戸医療センター 血液内科 Department of Hematology, National Hospital Organization Mito Medical Center
    • 横山 泰久 YOKOYAMA Yasuhisa
    • 筑波大学附属病院 血液内科|筑波大学医学医療系 血液内科 Department of Hematology, University of Tsukuba Hospital|Department of Hematology, Faculty of Medicine, University of Tsukuba
    • 小原 直 OBARA Naoshi
    • 筑波大学附属病院 血液内科|筑波大学医学医療系 血液内科 Department of Hematology, University of Tsukuba Hospital|Department of Hematology, Faculty of Medicine, University of Tsukuba
    • 長谷川 雄一 HASEGAWA Yuichi
    • 筑波大学附属病院 血液内科|筑波大学医学医療系 血液内科 Department of Hematology, University of Tsukuba Hospital|Department of Hematology, Faculty of Medicine, University of Tsukuba

Abstract

<p>53歳男性。成人T細胞リンパ腫(ATL)に対しmLSG15療法により第一寛解となるも肝腫瘤にて再発。Mogamulizumab(Mog)と放射線照射により腫瘤は消失,第二寛解に至った。Mog最終投与から65日後に,HLA3/8血清型不一致である娘をドナーとして末梢血幹細胞移植が施行された。移植後CY法(PT-CY)が用いられ重篤な急性GVHDの発症はなく経過したが,口腔粘膜,皮膚の慢性GVHDを発症し治療に難渋した。その後原病の第三再発にて永眠した。MogはCCR4陽性のATL細胞だけでなく制御性T細胞(Treg)も傷害するため移植後のGVHDや治療関連死亡を増加させる。Mog投与後のPT-CYを用いたHLA半合致同種幹細胞移植の検討は行われておらず,安全性の確立には今後の症例の蓄積や前向きな検討が必要であると考えられた。</p>

<p>A 53-year-old man diagnosed with adult T-cell lymphoma (ATL) was treated with mLSG15 chemotherapy and achieved a first complete remission. Subsequently, a liver tumor emerged that was pathologically diagnosed as ATL (first relapse). A second remission was achieved after local irradiation and four cycles of mogamulizumab treatment. The patient received peripheral blood stem cell transplantation (HSCT) from a one haplotype HLA-mismatched daughter after total body irradiation and the administration of fludarabine as a myeloablative conditioning regimen, followed by post-transplant cyclophosphamide. While subsequent acute graft-versus-host disease (GVHD) was never more than Grade I, severe chronic GVHD (cGVHD) developed in the oral cavity and skin that was resistant to escalated doses of cyclosporine and prednisolone. The patient subsequently had a second relapse of ATL as a subcutaneous mass and eventually died of disease progression. Mogamulizumab is a humanized monoclonal IgG that targets CC chemokine receptor 4 (CCR4) and is a key treatment option for relapsed ATL. It reportedly increases the risk of acute GVHD after HSCT due to the depletion of CCR4-positive regulatory T-cells; however, information on its impact on cGVHD is unavailable. Here, we discuss the potential risks and benefits of mogamulizumab, particularly in a haploidentical donor setting during a HSCT for ATL.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 58(5), 449-454, 2017

    The Japanese Society of Hematology

Codes

  • NII Article ID (NAID)
    130005690164
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • ISSN
    0485-1439
  • NDL Article ID
    028305790
  • NDL Call No.
    Z19-295
  • Data Source
    NDL  J-STAGE 
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