Cyclosporine in Relapsed Subcutaneous Panniculitis-like T-Cell Lymphoma after Autologous Hematopoietic Stem Cell Transplantation

Abstract

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare T-cell lymphoma characterized by involvement of the subcutaneous tissue of neoplastic T lymphocytes. SPTCL with hemophagocytic syndrome (HPS) is associated with an aggressive clinical course and treatment of SPTCL with HPS is not well established. Cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) therapy is not successful in most patients suffering from SPTCL with HPS. The role of high dose chemotherapy followed by hematopoietic stem cell transplantation (HSCT) remains controversial. We report a case of relapsed SPTCL after CHOP chemotherapy and salvage chemotherapy followed by autologous HSCT, which had rapid improvement within weeks after cyclosporine and prednisolone. Immunosuppressive therapy may be an important and successful treatment option in SPTCL patients, even though they may have clinically aggressive disease.

Keywords: Cyclosporine; Lymphoma; Panniculitis; T-lymphocytes.

Fig. 1

Radiologic finding. (A) Abdominal computed tomography shows an enhancing nodule in the subcutaneous layer of the low abdominal wall. (B) Positron emission tomography shows numerous fludeoxyglucose uptakes in the subcutaneous layer of the whole body.

Fig. 2

Tumor pathology. (A) Histopathology of subcutaneous nodule showing neoplastic lymphoid cells infiltrating mainly lobular areas of subcutaneous tissue (H&E staining, ×400). Immunohistochemical stains showing the rimming of individual fat spaces by tumor cells with staining for CD3 (B) and CD8 (C) (H&E staining, ×400). (D) Tumor cells do not express the CD56 phenotype (H&E staining, ×200).