Extensive cutaneous ALK-negative anaplastic large cell lymphoma with sustained response to brentuximab maintenance
ALK-negative anaplastic large cell lymphoma (ALCL) is an uncommon peripheral T-cell lymphoma that may present with extensive cutaneous involvement. Evidence regarding brentuximab vedotin maintenance in transplant-ineligible patients is limited.
Materials and Methods/Case Presentation/Objective:
A 53-year-old man with advanced HIV infection and severe chronic obstructive pulmonary disease presented with extensive, rapidly progressive nodular and tumoral cutaneous lesions involving the left hemithorax and back (Figure 1), associated with weight loss and bulky axillary lymphadenopathy. Skin biopsy confirmed CD30-positive, ALK-negative anaplastic large cell lymphoma with a high proliferative index (Ki-67 approximately 100%). Baseline PET-CT demonstrated extensive cutaneous, nodal and bone involvement.
The patient received brentuximab vedotin plus cyclophosphamide, doxorubicin and prednisone (BV-CHP), achieving a near-complete metabolic response after three cycles (Deauville 3). End-of-treatment PET-CT showed a residual hypermetabolic axillary node (Deauville 5); however, biopsy revealed necrosis without viable lymphoma. Cutaneous lesions markedly improved, with only residual skin changes remaining (Figure 2).
Due to severe respiratory comorbidities, autologous stem cell transplantation was not feasible. Brentuximab vedotin maintenance was initiated, leading to progressive flattening and regression of the skin lesions (Figure 3), together with a complete metabolic response on follow-up PET-CT (Deauville 3). Treatment was discontinued after five cycles because of grade 3 peripheral neuropathy. Despite treatment discontinuation, complete metabolic remission has been maintained for at least 6 months of follow-up.
Results/Description/Main Outcome Measure(s): This case highlights extensive cutaneous ALK-negative ALCL in a patient ineligible for autologous transplantation. Brentuximab vedotin maintenance achieved durable metabolic remission despite limited supporting evidence. Treatment was discontinued because of peripheral neuropathy, while complete remission was maintained.
Conclusion(s).: In conclusion, this case highlights the potential utility of brentuximab vedotin maintenance in selected transplant-ineligible patients with ALK-negative ALCL. Further studies are needed to better define its role outside standard consolidation strategies
Trademarked Items:
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