Two cases of fatal opportunistic infections occured in ATL patients treated with mogamulizumab
演題番号 : PS-1-234
玉城 啓太 （Keita Tamaki):1、西 由希子 （Yukiko Nishi):1、友寄 毅昭 （Takeaki Tomoyose):1、仲地 佐和子 （Sawako Nakachi):2、島袋 奈津紀 （Natsuki Shimabukuro):2、手登根 伊織 （Iori Tedokon):1、森近 一穂 （Kazuho Morichika):1、福島 卓也 （Takuya Fukushima):3、青山 肇 （Hajime Aoyama):4、益崎 裕章 （Hiroaki Masuzaki):1
1:2nd Dept. Int. Med., the University of the Ryukyus, Japan、2:Bone Marrow Transplantion Center, Ryukyu University Hospital, Japan、3:Lab. Immunohematology, Health Sciences, University of the Ryukyus, Japan、4:Dept, Pathology and Oncology, University of the Ryukyus, Japan
Mogamulizumab is a brand-new therapeutic modality for ATL. This agent binds C-C chemokine receptor 4 (CCR4) expressing in ATL cells, and activates natural killer cells in a manner of antibody-dependent cellular cytotoxicity (ADCC). Although mogamulizumab is a promising agent for ATL, there is not enough evidence of toxicity profile.
A 65-years-old male patient with refractory ATL acute type. After the treatment of VCAP-AMP-VECP, mogamulizumab was administered two cycles. Consequently, the number of peripheral lymphocyte decreased rapidly (absolute lymphocyte number range: 0-100/μL), thereby causing cytomegalovirus enteritis, gram-negative bacterial sepsis, pulmonary aspergillosis, and parainfluenza pneumonia, resulting in death of respiratory failure. However, ATL was keeping complete remission.
A 44-years-old female patient with relapse ATL acute type. After the treatment of CHOP and VCAP-AMP-VECP, mogamulizumab was administered six cycles. Similar to the first case, she suffered from opportunistic infections, oral ulceration caused by cytomegalovirus, BK virus cystitis, candida septicemia, and pneumocystis jiroveci pneumonia. In contract, ATL continued to remain stable.
Based on these cases, it is likely to speculate that, mogamulizumab would provoke severe immunosuppression in patients with ATL. It may be useful to consider differential diagnosis of opportunistic infections as stem cell transplantation.