Open AccessResolution of Melanoma to Programmed Death-1 Blockade but Simultaneous Rapid Progression of Concomitant Chronic Lymphocytic Leukemia
Author(s) -
Melinda Burgess,
Colm Keane,
Joshua W.D. Tobin,
Soi Cheng Law,
Alison Griffin,
Devinder Gill,
Adam D. Ewing,
Victoria Atkinson,
Peter Mollee,
Muhammed B. Sabdia,
Nicholas A. Saunders,
Maher K. Gandhi
Publication year - 2022
Publication title -
acta haematologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 56
eISSN - 1421-9662
pISSN - 0001-5792
DOI - 10.1159/000527631
Subject(s) - chronic lymphocytic leukemia , ibrutinib , blockade , immune checkpoint , medicine , melanoma , cd80 , concomitant , cancer research , ctla 4 , oncology , immunology , leukemia , immune system , t cell , biology , cd40 , cytotoxic t cell , receptor , in vitro , biochemistry
Here, we present a novel case of a patient with chronic lymphocytic leukemia (CLL) who received CTLA-4 and then PD-1 immune-checkpoint blockade (ICB) as treatment for concomitant metastatic melanoma. Whereas the metastatic melanoma was responsive to ICB, the CLL rapidly progressed (but responded to ICB cessation and ibrutinib). There were no new genetic mutational drivers to explain the altered clinical course. PD-1/PD-L1/PD-L2 and CTLA-4/CD80/CD86 expression was not increased in CLL B cells, CD8+ or CD4+ T-cell subsets, or monocytes. The patient's CLL B cells demonstrated strikingly prolonged in vitro survival during PD-1 blockade, which was not observed in samples taken before or after ICB, or with other patients. To our knowledge, a discordant clinical course to ICB coupled with these biological features has not been reported in a patient with dual malignancies.