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Rapid T-cell lymphoma progression associated with immune checkpoint inhibitors

Akihiro Ohmoto1,2, Shigeo Fuji3

  • 1Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Expert Review of Hematology
|May 16, 2023
PubMed
Abstract

Insights

Immune checkpoint inhibitors (ICIs) can cause rapid T-cell lymphoma progression, particularly in adult T-cell leukemia/lymphoma (ATLL). Predicting and differentiating this hyperprogression from pseudoprogression is crucial for patient outcomes.

Area of Science:

  • Oncology
  • Immunotherapy
  • Hematology

Background:

  • Immune checkpoint inhibitors (ICIs) represent a significant advancement in cancer treatment.
  • Anti-programmed death-1 (PD-1) antibodies are approved for classical Hodgkin lymphoma.
  • However, T-cell lymphoma trials were halted due to hyperprogression after ICI administration.

Purpose of the Study:

  • To review the rapid progression of peripheral T-cell lymphoma, including adult T-cell leukemia/lymphoma (ATLL).
  • To explore potential mechanisms behind ICI-induced hyperprogression.
  • To highlight the importance of distinguishing hyperprogression from pseudoprogression.

Main Methods:

  • Review of existing literature on ICI therapy in T-cell lymphomas.
  • Analysis of patient data from terminated phase 2 trials.
  • Discussion of proposed mechanisms for hyperprogression.

Main Results:

  • Hyperprogression was predominantly observed in ATLL and angioimmunoblastic T-cell lymphoma subtypes.
  • Potential mechanisms include compensatory checkpoint upregulation and altered immune microenvironments.
  • No reliable methods currently exist to predict hyperprogression before ICI treatment.

Conclusions:

  • Hyperprogression is a critical concern in ICI therapy for certain T-cell lymphomas.
  • Distinguishing hyperprogression from pseudoprogression is essential for clinical management.
  • Future advancements in diagnostic tools may aid in early detection and prediction.
Keywords:
ATLLAnti-PD1 antibodyICINTFHL-AIhyperprogression

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