PMC9813186_01
Computed tomography (CT) images of the chest at the initial diagnosis of adult T-cell leukemia/lymphoma (ATLL) (A), before bone marrow transplantation (B), during post-transplant relapse (C), and 2 months after mogamulizumab (MOG) therapy (D)
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Fig1
PB, skin, and lung findings (Fig. 1A). Partial lobectomy was performed for the lung lesions. After combination chemotherapy, she achieved remission (Fig. 1B) and received bone marrow transplantation (BMT) from a human leukocyte antigen-matched unrelated donor, with a reduced conditioning regimen of fludarabine 25 mg/m2 (day-7 to day-3), melphalan 80 mg/m2 (day-2), and total body irradiation 4 Gy (day-1). The LN, lung (Fig. 1D), and skin lesions gradually regressed.
Clinical course. BMT bone marrow transplantation, MTX methotrexate, Tac CI tacrolimus continuous infusion, Tac PO tacrolimus oral administration, ATLL adult T-cell leukemia/lymphoma, MOG mogamulizumab, PSL prednisolone, PBMC peripheral blood mononuclear cell, mLSG-15 mLSG-15 salvage chemotherapy
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Fig2
However, as shown in Fig. 2, 3 months after BMT, PB, skin, lung (Fig. 1C), and LN lesions recurred.
Hematoxylin and eosin-stained skin biopsy tissues performed during the recurrence of cutaneous acute GVHD after post-transplant mogamulizumab administration (original magnification x 100). The arrow shows an apoptotic cell
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Fig3
However, as shown in Fig. 2, 3 months after BMT, PB, skin, lung (Fig. 1C), and LN lesions recurred. GvHD was confirmed by skin biopsy (Fig. 3), which revealed mild vacuolar changes associated with apoptotic cells and lymphocytic inflammatory cells at the epidermal-dermal interface.
Expression of the C-terminus of CCR4 in skin lesions at post-transplant relapse. The skin lesions showed an infiltrate of medium to large-sized atypical lymphocytes (A, hematoxylin-eosin (HE) stain, original magnification x 100). The atypical cells formed Pautrier-like microabscesses and were immunohistochemically positive for the N-terminus of CCR4 (B, CCR4-N-IHC) and the C-terminus of CCR4 (C, CCR4-C-IHC)
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Fig4
TEST IHC, MINARIS Medical Cooperation, Tokyo, Japan) and C-terminus (amino acids 335-360: Novus Biologicals, CO, USA) of CCR4 and skin biopsy samples obtained at post-transplant relapse. The tumor cells were strongly positive for CCR4-C-IHC as well as CCR4-N-IHC (Fig. 4).