Development of a biclonal cutaneous T-cell lymphoproliferative process during treatment with immune checkpoint inhibitors for metastatic melanoma

Jonathan J Davick; Mark R Wick; Alejandro A Gru

doi:10.1097/CMR.0000000000000371

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Development of a biclonal cutaneous T-cell lymphoproliferative process during treatment with immune checkpoint inhibitors for metastatic melanoma

Journal article

Peer reviewed

Development of a biclonal cutaneous T-cell lymphoproliferative process during treatment with immune checkpoint inhibitors for metastatic melanoma

Jonathan J Davick, Mark R Wick and Alejandro A Gru

Melanoma research, Vol.27(4), pp.383-386

08/2017

DOI: 10.1097/CMR.0000000000000371

PMID: 28574977

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Abstract

The immune checkpoint inhibitors targeting cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) and the programmed death protein 1 (PD-1)/PD-L1 pathway have recently shown promising therapeutic results in patients with metastatic melanoma. Dermatologic side effects of these agents occur in ∼30-40% of cases. Here, we report the development of a biclonal cutaneous T-cell lymphoproliferative disorder in a patient being treated with ipilimumab (a CTLA-4 inhibitor) for metastatic melanoma. Nivolumab (a PD-1 inhibitor) had also been administered to him previously. An 8 mm reddish papule appeared on the skin of the left forearm. A biopsy of that lesion showed an atypical population of predominantly CD4-positive, CD30-positive T-cells that also expressed PD-1 and PD-L1 immunohistochemically. PCR studies for T-cell receptor rearrangements showed the presence of two distinct clonal T-cell populations. The lesion was completely excised and the patient had no local recurrences. There was also no subsequent evidence of a systemic lymphoproliferative process. Although the development of a lymphoid skin lesion in our patient may have only been coincidentally related to his treatment, immunostimulatory drugs could theoretically cause clonal expansion of a population of lymphocytes that leads to a lymphoproliferative disorder.

Aged

Antibodies, Monoclonal - pharmacology

Antibodies, Monoclonal - therapeutic use

CTLA-4 Antigen - therapeutic use

Humans

Immunotherapy - methods

Male

Melanoma - drug therapy

Melanoma - pathology

Skin Neoplasms - drug therapy

Skin Neoplasms - pathology

Details

Title: Subtitle: Development of a biclonal cutaneous T-cell lymphoproliferative process during treatment with immune checkpoint inhibitors for metastatic melanoma
Creators: Jonathan J Davick - University of Virginia
Mark R Wick
Alejandro A Gru
Resource Type: Journal article
Publication Details: Melanoma research, Vol.27(4), pp.383-386
DOI: 10.1097/CMR.0000000000000371
PMID: 28574977
ISSN: 0960-8931
eISSN: 1473-5636
Language: English
Date published: 08/2017
Academic Unit: Pathology
Record Identifier: 9984186495502771

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