Durable Response to Brentuximab Vedotin Plus Cyclophosphamide, Doxorubicin, and Prednisone (BV-CHP) in a Patient with CD30-Positive PTCL Arising as a Post-Transplant Lymphoproliferative Disorder (PTLD)

Abstract

T-cell PTLDs are lymphoid proliferations that develop in recipients of SOT or allogeneic HSCT. They carry an extremely poor prognosis with a reported median survival of only 6 months. The infrequency with which they are encountered makes treatment a challenge due to the lack of prospective trials to guide management. The significantly higher risk of morbidity and mortality in T-cell PTLD, compared to B-cell PTLD, underscores the challenge of treating these patients and the need for new therapeutic options. Brentuximab vedotin, an ADC targeting CD30, is FDA-approved in combination with CHP as front-line treatment for patients with CD30 expressing PTCL. Herein we report a case of CD30-positive T-cell PTLD that was successfully treated with BV-CHP, suggesting the added value of the addition of BV to chemotherapy, contributing to our patient's long and ongoing progression-free survival. To our knowledge, this is the first documented case of successful treatment using BV-CHP for a CD30-positive, EBV-negative, late T-cell PTLD.

Keywords: BV-CHP; CD30; NOS; T-cell; brentuximab; peripheral T-cell lymphoma; post-transplant lymphoproliferative disorders.

Figure 1

Comparison of baseline, interim, and end-of-treatment (EOT) PET-CT. (A) An abnormal 5.8 × 3.9 cm² soft tissue mass (SUV 11.9) adjacent to the proximal right femur demonstrates near complete resolution after cycle 4 (SUV 1.68) (B) and complete resolution after cycle 6 (C). (D) Enhancing mediastinal adenopathy (max SUV 13.4, Deauville Score 5) with significant improvement (SUV 9.3, Deauville Score 4) after cycle 4 (E) maintained after cycle 6 (Deauville Score 4) (F). (G) Abnormal FDG uptake of numerous subcentimeter bilateral pulmonary nodules (max SUV 8.4) with complete resolution after cycle 4 (H) and maintained after cycle 6 (I).

Figure 2

Histologic morphology and immunohistochemical stains on the soft tissue mass. (A) The tumor shows a diffuse infiltration of large, atypical lymphocytes in a fibrohistiocytic background (Hematoxylin and Eosin ×400). The lymphoma cells express CD3 (B), CD30 (30% of lymphocytes) (C) and are negative for CD5 (×400) (D).