Benefit of prednisolone alone in nodal peripheral T-cell lymphoma with T follicular helper phenotype

Abstract

A 71-year-old Japanese man presented with severe thrombocytopenia. A whole-body CT at presentation showed small cervical, axillary, and para-aortic lymphadenopathy, leading to suspicion of immune thrombocytopenia due to lymphoma. Biopsy was difficult to perform because of severe thrombocytopenia. Thus, he received prednisolone (PSL) therapy and his platelet count gradually recovered. Two and a half years after PSL therapy initiation, his cervical lymphadenopathy slightly progressed without other clinical symptoms. Hence, a biopsy from the left cervical lymph node was performed, and he was diagnosed with nodal peripheral T-cell lymphoma (PTCL) with T follicular helper (TFH) phenotype. Due to various complications, we continued treatment with prednisolone alone after the diagnosis of lymphoma; however, there was no further increase in lymph node enlargement and no other lymphoma-related symptoms for one and a half years after diagnosis. Although immunosuppressive therapy has been reported to produce a response in some patients with angioimmunoblastic T-cell lymphoma, our experience suggests that a similar subset may exist in patients with nodal PTCL with TFH phenotype, which has the same cellular origin. Immunosuppressive therapies may constitute an alternative treatment option even in the era of novel molecular-targeted therapies, especially for elderly patients who are ineligible for chemotherapy.

Clinicopathologic analysis of nodal T-follicular helper cell lymphomas, a multicenter retrospective study from China

“…Our findings corroborate this statement, as our study revealed that patients with nTFHL-NOS exhibited milder clinical manifestations, fewer laboratory and imaging abnormalities, less advanced-stage disease, and improved treatment response and survival. Furthermore, several case reports have substantiated these findings (17)(18)(19)(20)(21). Despite the absence of significant differences in clinical features between nTFHL-AI patients and nTFHL-F patients as well as nTFHL-NOS patients, patients with nTFHL-F exhibited worse survival outcomes, possibly indicating a more unfavorable prognostic subtype.…”