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Updated: Aug 10, 2026
Radial Mobility and Cytotoxic Function of Retroviral Replicating Vector Transduced, Non-adherent Alloresponsive T Lymphocytes
Published on: February 11, 2015
[CD30-negative diffuse large B-cell lymphoma expressing ALK]
Kazuyoshi Ishii1, Yoshihisa Yamamoto, Shosaku Nomura
1Department of Hematology, Kishiwada City Hospital.
Insights
A patient with refractory anaplastic large cell lymphoma achieved complete remission after allogeneic stem cell transplant. The graft-versus-lymphoma effect likely contributed to sustained remission, despite a fatal outcome from thrombotic microangiopathy.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- A 33-year-old man presented with undifferentiated carcinoma and lymphadenopathy, later diagnosed as anaplastic large cell lymphoma.
- The patient experienced relapse twice despite chemotherapy (CHOP) and achieved complete remission (CR) after initial treatment.
Observation:
- The patient underwent allogeneic peripheral blood stem cell transplantation (PBSCT) from an HLA-matched sibling while in non-CR.
- Engraftment and complete chimerism were achieved, followed by acute and chronic graft-versus-host disease (GVHD), which were managed with immunosuppression.
- The patient achieved CR post-PBSCT and maintained complete chimerism.
Findings:
- Tumor cells were ALK-positive, CD30-negative, with JH rearrangement, classified as diffuse large B-cell lymphoma with ALK expression.
- Despite chemotherapy resistance and a complex karyotype, PBSCT led to sustained CR.
- The patient died seven months post-PBSCT due to fulminant thrombotic microangiopathy.
Implications:
- Allogeneic PBSCT can induce sustained remission in refractory lymphomas, potentially through a graft-versus-lymphoma effect.
- This case highlights the complex interplay between GVHD, immunosuppression, and anti-tumor responses post-transplant.
- Further research into optimizing stem cell transplantation strategies for refractory lymphomas is warranted.
Abstract:
A 33-years-old man was diagnosed as having undifferentiated carcinoma presenting with right neck lymphadenopathy in December 2000. He obtained complete remission (CR) following chemotherapy, radiation and lymphadenectomy on the right neck. He had multiple para-aorta lymphadenopathy and splenomegaly in December 2001. An open-abdominal lymph node biopsy was performed from which a diagnosis of anaplastic large cell lymphoma was made. CR was achieved with biweekly CHOP, however, the patient suffered from a relapse twice. He underwent allogeneic peripheral blood stem cell transplantation (PBSCT) from his HLA-matched sister while in non-CR in November 2002. Engraftment was achieved on day 14, and at the same time, complete chimerism was confirmed. Acute grade III graft-versus-host disease (GVHD) developed and was controlled with cyclosporine A and prednisolone. Extensive chronic GVHD was subsequently observed and required systemic immunosuppression. His condition returned to CR after the PBSCT and he sustained complete chimerism. He suddenly died of fulminant thrombotic microangiopathy seven months after the PBSCT. The tumor cells were ALK-positive, CD30-negative and JH rearrangement was detected, and were therefore classified as diffuse large B-cell lymphoma with expression of ALK according to the WHO classification, though they differed from this subtype in some points. Although this case was refractory for chemotherapy with a complex karyotype, the graft-versus-lymphoma effect might have contributed to the sustained CR following the PBSCT.
