Dramatic response to brentuximab vedotin in refractory nontransformed CD 30 ^– mycosis fungoides allowing allogeneic stem cell transplant and long‐term complete remission

Abstract

Summary The erythrodermic ulcerated form of mycosis fungoides (MF) is exceptional, and treatment of refractory cases is challenging. Brentuximab vedotin (BV) is a monoclonal antibody combined with monomethyl auristatin E, recently approved for the treatment of refractory CD30+ cutaneous T‐cell lymphoma. We report a case of refractory MF in a 56‐year‐old man with a long history of large‐plaque parapsoriasis, as revealed by psoriasiform erythroderma, treated initially with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) polychemotherapy, inducing a 2‐year complete response. After relapse, interferon and gemcitabine were unsuccessful. Finally, treatment with BV was decided upon, despite the absence of CD30 expression. After three infusions of BV 1·8 mg kg−1, we achieved a complete and stable response, allowing an allogeneic stem cell transplant. The patient is still in complete remission, 19 months after the graft. This case illustrates the possibility of using BV in refractory CD30– MF as a salvage therapy.

Impressive response of CD30‐negative, treatment‐refractory mycosis fungoides to brentuximab vedotin

“…In this report, we present a patient with CD30‐negative MF who demonstrated a dramatic response to brentuximab. Two similar cases have been published in the literature (Mahevas et al, ; Zhang, Chairatchaneeboon, Haun, Landsburg, & Kim, ).…”

Allogeneic Hematopoietic Stem Cell Transplantation in Cutaneous T-Cell Lymphomas

“…Thus, BV may be a good option, alone or in combination, as a bridge therapy for allo-HSCT in CTCL with poor prognosis. BV has also shown efficacy in patients with CD30-negative disease [ 32 ]), probably due to the variability in CD30 expression from one lesion to another in the same patient [ 33 ].…”

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“…Bei CD30-positiven Erkrankungen steht das anti-CD30-Antikörper-Zytostatikum-Konjugat Brentuximab-Vedotin (anti-CD30 mAB und Monomethylauristatin E) mit guten Ergebnissen zur Verfügung [3,5]. In Einzelfällen kam Brentuximab-Vedotin auch bei nicht oder nur schwach CD30-positiven Lymphomen erfolgreich zum Einsatz [6,7]. Zu den weiteren, bereits heute entsprechend der individuellen Charakterisierung bei fortgeschrittenen CTCL einsetzbaren, zielgerichteten Therapieoptionen zählen Antimetabolite, Histondeacetylase (HDAC-)Hemmer, Proteasominhibitoren und Inhibitoren der anaplastischen Lymphozytenkinase (ALK) und des JAK-/STAT-Signalwegs sowie der anti-CCR4-Antikörper Mogamulizumab [8 -10].…”