A novel treatment for gray zone lymphoma has been proposed by US researchers.
This rare subtype mixes aspects of Hodgkin and Non-Hodgkin lymphoma.
Writing in the New England Journal of Medicine, Dr Christopher Melani of the National Cancer Institute, Maryland, USA, say: 'Mediastinal gray-zone lymphoma lies intermediate between nodular-sclerosis classic Hodgkin's lymphoma and primary mediastinal B-cell lymphoma.'
It has 'overlapping clinical, histologic, and molecular features,' they add, such as shared genetic characteristics.
They report on three patients with refractory mediastinal gray-zone lymphoma successfully treated with PD-1 blockade, which targets the programmed death 1 (PD-1) pathway believed to play a key role in lymphomagenesis.
The first patient, an 18 year old woman, did not respond well to standard treatment, but had a "complete metabolic response" to the PD-1 blockade drug pembrolizumab.
The second case, a 76 year old man, suffered disease progression following partial response to standard treatment. He also had a complete metabolic response after treatment with pembrolizumab.
The final case, an 80 year old woman, had a complete metabolic response to standard treatment, but then relapsed and experienced disease progression. She is now in remission after treatment with the PD-1 blockade drug nivolumab.
The authors write: 'Nivolumab and pembrolizumab have a high frequency of response in relapsed or refractory classic Hodgkin's lymphoma but not in primary mediastinal B-cell lymphoma. Recent findings indicate that mediastinal gray-zone lymphoma may be more closely related to classic Hodgkin's lymphoma than to primary mediastinal B-cell lymphoma.
'These findings suggest that PD-1 inhibitors may be therapeutically important for mediastinal gray-zone lymphoma, which is more resistant to treatment than classic Hodgkin's lymphoma or primary mediastinal B-cell lymphoma.'
Source: Melani, C. et al. PD-1 Blockade in Mediastinal Gray-Zone Lymphoma. New England Journal of Medicine 6 July 2017 doi: 10.1056/NEJMc1704767
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