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

Abstract

Brentuximab vedotin is a CD30‐antibody/drug conjugate which has demonstrated excellent response in treating CD30‐positive mycosis fungoides (MF) and anaplastic large cell lymphoma (ALCL). In this report, we present a patient with CD30‐negative MF refractory to multiple other lines of therapy who demonstrated a dramatic response to brentuximab. This paradoxical response may be due to inadequate detection of CD30 expression by immunohistochemical techniques. From this case we see that even in the setting of apparent CD30 negativity, brentuximab may be a viable treatment option for patients who require bridging to stem cell transplant or seek successful palliation. This case highlights the point that rigid inclusion criteria for MF trials without use of more sensitive techniques to confirm lack of CD30 expression may inappropriate.

Clinical Response to Anti-CD47 Immunotherapy Is Associated with Rapid Reduction of Exhausted Bystander CD4+ BTLA+ T Cells in Tumor Microenvironment of Mycosis Fungoides

“…When taken in the context of early studies reporting CD30 expression to be enriched in disease states and among Th2 polarized human CD4 + T cells [ 46 , 47 , 48 ] and that Th2 cytokines fuel MF progression [ 49 ], a logical hypothesis would be that CD30 marks a subset of CD4 + T cells that can promote tumorigenesis by indirectly dampening the activation of cytotoxic cells through Th2 microenvironment skewing. This would provide a mechanistic understanding of why CD30 expression is a negative prognostic marker in MF [ 31 , 50 ] and how the targeted depletion of CD30 expressing cells with brentuximab vedotin can induce clinical responses in patients whose malignant cells are CD30 negative [ 51 , 52 ].…”

Multicentric MFI30 study: Standardization of flow cytometry analysis of CD30 expression in non‐Hodgkin lymphoma

“…Moreover, IHC standardization remains a challenge since it could be operator dependent (Koens et al, 2018). These limitations may give rise to paradoxical positive clinical results in IHC CD30‐negative lymphoma (Goyal, Hordinsky, & Lazaryan, 2019). Flow cytometry (FCM) is a powerful tool in the diagnosis of NHL in biological fluids (peripheral blood, bone marrow aspirate, pleural effusion, cerebrospinal fluid, brain biopsy rinse fluid [Debliquis et al, 2018], etc.)…”

Complete Remission of Relapsed Hodgkin’s Lymphoma following Brentuximab Vedotin and Gemcitabine Combination Therapy with Severe Hypotension as Possible Treatment-Related Adverse Event: A Case Report

“…In our patient, BV was suitable as multiple rounds of cytotoxic chemotherapy failed to achieve a satisfactory response, and the patient could not tolerate the side effects of these medications, resulting in repeated premature termination of treatment. Furthermore, BV has been observed to show benefit even in lymphoma patients not expressing CD30 [8]. After 5 cycles of BV monotherapy, the patient demonstrated remarkable clinical improvement which was the best outcome since her initial relapse.…”