BR-CHOP in composite angioimmunoblastic T-cell lymphoma and diffuse large B-cell lymphoma: case report

Background: Angioimmunoblastic T-cell lymphoma (AITL), a rare type of non-Hodgkin lymphoma, is often accompanied by B-cell proliferation and lymphomas, including diffuse large B-cell lymphoma (DLBCL). While Epstein-Barr virus (EBV) infection is frequently implicated in AITL-associated B-cell proliferation, cases of composite AITL and EBV-negative DLBCL are exceedingly rare. There is currently no standardized treatment for this composite lymphoma. The aim of this case report is to describe the successful use of a unique chemotherapy regimen (BR-CHOP: brentuximab vedotin, rituximab, cyclophosphamide, doxorubicin, prednisone) in the treatment of a rare case of composite AITL and EBV-negative DLBCL. Case Description: We present a case of a 71-year-old female with chronic hepatitis B virus (HBV) who was diagnosed with composite AITL and EBV-negative CD30+ DLBCL. At the time of admission, she had autoimmune hemolytic anemia and leukocytosis. She completed all six cycles of BR-CHOP therapy. Following treatment, she achieved remission for 2 years, with resolution of symptoms and normalization of blood counts. Follow-up imaging, however, identified recurrence of the cancer. Conclusions: To our knowledge, this is the first case of composite AITL with EBV-negative DLBCL where BR-CHOP treatment was successfully completed and resulted in a complete remission for 2 years. After 2 years of remission, the patient had a relapse and ultimately passed away with disease progression during the relapse. This case highlights the challenges in managing rare composite lymphomas where optimal treatment strategies are not completely elucidated, and it underscores the therapeutic efficacy of BR-CHOP in such cases. Keywords: Angioimmunoblastic T-cell lymphoma (AITL); diffuse large B-cell lymphoma (DLBCL); composite lymphoma; brentuximab vedotin (BV); case report