A suspicion of chikungunya leading to a diagnosis of angioimmunoblastic T-cell lymphoma

Figures & data

Figure 1.  A. Initial ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) reveals mild FDG activity in bilateral jugulodigastric (standardized uptake value [SUV] of 3.5) and axillary lymph nodes (SUV of 2.7) with additional uptake noted in the right supraclavicular, right hilar, subcarinal, portocaval, mesenteric, retroperitoneal, iliac (SUV of 13.8), and inguinal lymph nodes. There is an enlargement of the spleen with increased activity (SUV of 7.1) as well. B. Compared to the examination obtained at diagnosis, the repeat PET scan obtained a year later shows complete remission of the disease, with no enlarged FDG-avid nodes in the neck, chest, abdomen, or the pelvis.

Figure 2.  PET/CT scan shows numerous subcutaneous FDG-avid nodules (arrows) of cutaneous involvement by the lymphoma in the shoulder, chest wall, and axilla.

Table I.  Selected published studies and reports on the treatment of AITL.

Regimen	Type of study	Number of patients	Outcome	Author (year)
High dose chemotherapy + /− Autologous HSCT	Registry review	N = 143	CR = 70%, RR + SD = 87% Median remission = 24 months OS = 59% at 4-years	Kyriakou et al. (2008) [23]
Cyclosporine	Case series	N = 12	CR = 25%, RR = 67% Duration of remission = 2- 44+ months	Advani et al. (2007) [17]
High dose chemotherapy + /− Autologous HSCT	Case series	N = 19	CR = 79% OS = 60% at 2-years	Rodriguez et al. (2007) [24]
Alemtuzumab	Case report	N = 1	–	Halene et al.^†† (2006) [5]
Thalidomide	Case report	N = 1	–	Dogan et al.^†† (2005) [5]
High dose chemotherapy + /− Autologous HSCT	Case series	N = 29	CR = 25% OS = 44% at 5-years	Schetelig et al.^†† (2003) [5]
Methotrexate +Prednisone	Case report	N = 1	–	Gerlando et al. (2001) [26]
Methotrexate +Prednisone	Case series	N = 2	–	Quintini et al. (2001) [21]
Fludarabine	Case report	N = 1	–	Bourgeois et al. (2000) [27]
Fludarabine	Case series	N = 2	–	Hast et al. (1999) [28]
Cyclophosphamide, Doxorubicin, Vincristine, Prednisone (CHOP)	Case series	N = 33	CR = 61% Median remission = 26 months OS = 65.4% at 2-years OS= 36.1% at 5-years	Pautier et al. (1999) [29]
2-CdA	Case series	N = 7	CR = 28.5%, RR = 57% Median remission = 10.5 months	Sallah et al.^†† (1999) [19]
Prednisone + COPBLAM/IM VP-16^†	Phase II study	N = 39	CR = 64% Median remission = 15 months OS = 34% at 3-years	Siegert et al.^†† (1992) [5]
Interferon-alpha	Case series	N = 12	Median remission = 3.5 months	Siegert et al.^†† (1991) [5]

^† COPBLAM/IM VP-16 = cyclophosphamide, vincristine, prednisolone, bleomycin, doxorubicin, procarbazine, ifosfamide, methotrexate, and etoposide

^†† Citation available in manuscript by Dunleavy et al. [10].Abbreviations: CR = complete remission, OS = overall survival, RR = response rate.

Kyriakou C, Canals C, Goldstone A, Caballero D, Metzner B, Kobbe G, et al. High-dose therapy and autologous stem-cell transplantation in angioimmunoblastic lymphoma: Complete remission at transplantation is the major determinant of Outcome-Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2008; 26(2)218–24

 PubMed Web of Science ®Google Scholar

Advani R, Horwitz S, Zelenetz A, Horning SJ. Angioimmunoblastic T cell lymphoma: Treatment experience with cyclosporine. Leuk Lymphoma 2007; 48: 521–5

 PubMed Web of Science ®Google Scholar

Rodriguez J, Conde E, Gutierrez A, Arranz R, Gandarillas M, Leon A, et al. Prolonged survival of patients with angioimmunoblastic T-cell lymphoma after high-dose chemotherapy and autologous stem cell transplantation: The GELTAMO experience. Eur J Haematol 2007; 78(4)290–6

 PubMed Web of Science ®Google Scholar

Dunleavy K, Wilson WH, Jaffe ES. Angioimmunoblastic T cell lymphoma: Pathobiological insights and clinical implications. Curr Opin Hematol 2007; 14: 348–53

 PubMed Web of Science ®Google Scholar

Gerlando Q, Barbera V, Ammatuna E, Franco V, Florena AM, Mariani G. Successful treatment of angioimmunoblastic lymphadenopathy with dysproteinemia-type T-cell lymphoma by combined methotrexate and prednisone. Haematologica 2000; 85: 880–1

 PubMed Web of Science ®Google Scholar

Quintini G, Iannitto E, Barbera V, Turri D, Franco V, Florena AM, et al. Response to low-dose oral methotrexate and prednisone in two patients with angio-immunoblastic lymphadenopathy-type T-cell lymphoma. Hematol J 2001; 2: 393–5

 PubMedGoogle Scholar

Bourgeois E, Auxenfants E, Jouffrey C, Dubest C, Mahieu M, Rose C. Efficacy of fludarabine in the treatment of angioimmunoblastic lymphoma (AIL)]. Ann Med Interne (Paris) 2000; 151: 230–1

 PubMedGoogle Scholar

Hast R, Jacobsson B, Petrescu A, Hjalmar V. Successful treatment with fludarabine in two cases of angioimmunoblastic lymphadenopathy with dysproteinemia. Leuk Lymphoma 1999; 34: 597–601

 PubMed Web of Science ®Google Scholar

Pautier P, Devidas A, Delmer A, Dombret H, Sutton L, Zini JM, et al. Angioimmunoblastic-like T-cell non Hodgkin's lymphoma: Outcome after chemotherapy in 33 patients and review of the literature. Leuk Lymphoma 1999; 32((5–6))545–52

 PubMed Web of Science ®Google Scholar

Sallah S, Wehbie R, Lepera P, Sallah W, Bobzien W. The role of 2-chlorodeoxyadenosine in the treatment of patients with refractory angioimmunoblastic lymphadenopathy with dysproteinemia. Br J Haematol 1999; 104: 163–5

 PubMed Web of Science ®Google Scholar

Saito M, Fukuda T, Shiohara T, Homori M. Angioimmunoblastic T-cell lymphoma: A relatively common type of T-cell lymphoma in Sjogren's syndrome. Clin Exp Rheumatol 2005; 23: 888–90

 PubMed Web of Science ®Google Scholar