Activity of pembrolizumab in relapsed/refractory NK/T-cell lymphoma

Xin Li, Yasong Cheng, Mingzhi Zhang, Jiaqin Yan, Ling Li, Xiaorui Fu, Xudong Zhang, Yu Chang, Zhenchang Sun, Hui Yu, Lei Zhang, Xinhua Wang, Jingjing Wu, Zhaoming Li, Feifei Nan, Li Tian, Wencai Li, Ken H Young, Xin Li, Yasong Cheng, Mingzhi Zhang, Jiaqin Yan, Ling Li, Xiaorui Fu, Xudong Zhang, Yu Chang, Zhenchang Sun, Hui Yu, Lei Zhang, Xinhua Wang, Jingjing Wu, Zhaoming Li, Feifei Nan, Li Tian, Wencai Li, Ken H Young

Abstract

Natural killer/T-cell lymphoma (NKTCL) is a rare subtype of non-Hodgkin lymphoma that is associated with a poor outcome. Currently, the treatment needs of NKTCL remain unmet, and efforts to further improve treatment are urgently needed. Herein, seven patients with NKTCL who failed to respond to various types of chemotherapies were treated with the anti-programmed death 1 (anti-PD-1) antibody pembrolizumab at 100 mg every 3 weeks. After a median of four cycles of treatment (range 2-18), four out of seven patients responded (two complete response, two partial response, overall response rate 57%). Expression of PD1-ligand available was 50, 20, 30, 70, and 30% of five patients respectively. It is negative in one patient and not tested in one patient. Adverse events, which mostly ranged from grade I to grade III, were tolerable and could be safely handled, although immune-related pneumonitis was notable. Overall, PD-1 blockade with pembrolizumab represents a favorable strategy for the treatment of refractory/relapsed NKTCL.

Keywords: NK/T-cell lymphoma; PD-1 blockade; Pembrolizumab.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Zhengzhou University First Affiliated Hospital. All patients provided informed consent.

Consent for publication

Written informed consent for publication was obtained.

Competing interests

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Lesion changes of case 1 before and after pembrolizumab treatment. a The skin lesions of lower limbs of case 1 at the time of relapse. b The skin lesions responded after the first cycle. After 4 cycles, her crust of the lesions fell off and ulcers healed
Fig. 2
Fig. 2
Changes in circulating EBV DNA with pembrolizumab treatment. The EBV DNA levels in case 2 fell from 1330 copies/ml to

Fig. 3

PET/CT results of case 2.…

Fig. 3

PET/CT results of case 2. The scan of case 2 in the left…

Fig. 3
PET/CT results of case 2. The scan of case 2 in the left two images showed a relatively hypermetabolic lesion in mediastinal, hilar lymph nodes, and intestines after using pembrolizumab for 1 cycle. The two images on the right showed that the lesions were metabolically less active 2 cycles later

Fig. 4

HE staining and IHC of…

Fig. 4

HE staining and IHC of six patients available. The scan of case 2…

Fig. 4
HE staining and IHC of six patients available. The scan of case 2 in the left two images showed a relatively hypermetabolic lesion in mediastinal, hilar lymph nodes, and intestines after using pembrolizumab for 1 cycle. The two images on the right showed that the lesions were metabolically less active 2 cycles later
Fig. 3
Fig. 3
PET/CT results of case 2. The scan of case 2 in the left two images showed a relatively hypermetabolic lesion in mediastinal, hilar lymph nodes, and intestines after using pembrolizumab for 1 cycle. The two images on the right showed that the lesions were metabolically less active 2 cycles later
Fig. 4
Fig. 4
HE staining and IHC of six patients available. The scan of case 2 in the left two images showed a relatively hypermetabolic lesion in mediastinal, hilar lymph nodes, and intestines after using pembrolizumab for 1 cycle. The two images on the right showed that the lesions were metabolically less active 2 cycles later

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