Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10193-10200
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10193
Treatment of refractory/relapsed extranodal NK/T cell lymphoma with decitabine plus anti-PD-1: A case report
Lin-Jie Li, Jun-Yu Zhang
Lin-Jie Li, Jun-Yu Zhang, Department of Hematology, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
Author contributions: Zhang JY designed the report and wrote the paper; Li LJ collected the patient’s clinical data; all authors have read and approved the final version of this manuscript.
Supported by the Medical Health Science and Technology Project of Zhejiang Province Health Commission, No. 2020376298.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lin-Jie Li, Doctor, Chief Doctor, Department of Hematology, Lishui Municipal Central Hospital, No. 289 Kuocang Load, Lishui 323000, Zhejiang Province, China. lilinjie0394@163.com
Received: April 9, 2022
Peer-review started: April 9, 2022
First decision: June 16, 2022
Revised: June 24, 2022
Accepted: August 24, 2022
Article in press: August 24, 2022
Published online: October 6, 2022
Processing time: 167 Days and 4.5 Hours
Abstract
BACKGROUND

Extranodal natural killer/T cell lymphoma, nasal type (ENKL) is a highly aggressive malignancy characterized by its association with Epstein-Barr virus (EBV) and extranodal involvement, which shows a poor clinical outcome. Although L-asparaginase-based chemotherapy has improved the response rates of relapsed/refractory (R/R) ENKL, relapse occurs in up to 50% of patients with disseminated disease.

CASE SUMMARY

Immune evasion has emerged as a critical pathway for survival in ENKL and may be effectuated via STAT3-driven upregulation of programmed cell death ligand 1 (PD-L1) or other molecular pathways. Anti-PD-1 is effective for R/R ENKL with EBV-driven upregulation of PD-L1 expression. Anti-PD-1 combined with decitabine showed positive preliminary results in a patient with R/R ENKL and resistance to anti-PD-1.

CONCLUSION

The treatment experience, in this case, demonstrated the potential ability of decitabine combined with PD-1 inhibitor to treat R/R ENKL, thus providing a new treatment strategy for this tumor.

Keywords: NK-T cell lymphoma; Refractory/relapsed; Anti-PD-1; Decitabine; Case report

Core Tip: Extranodal natural killer/T cell lymphoma nasal type is a highly aggressive malignancy characterized by its association with Epstein-Barr virus and extranodal involvement, which shows a poor clinical outcome. Now, we report a rare case of relapsed/refractory classic Hodgkin lymphoma with resistance to anti-PD-1 in which anti-PD-1 combined with decitabine showed positive preliminary results. Our findings support the potential benefit of anti-PD-1 combined with decitabine in this type of refractory T-cell lymphoma.