Venovenous Extracorporeal Membrane Oxygenation (VV-ECMO) Support in Anaplastic Lymphoma Kinase (ALK)-Positive Anaplastic Large Cell Lymphoma With Pulmonary Involvement at Presentation

Anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma is a rare and aggressive peripheral T-cell lymphoma typically diagnosed at advanced stages. Although venovenous extracorporeal membrane oxygenation (VV-ECMO) has been associated with poor outcomes in patients with active hematological malignancies, emerging evidence points to a potential benefit for carefully selected patients with severe acute respiratory failure due to cancer. We describe the clinical case of a 19-year-old male who initially presented with pleuritic chest pain and fever. Following a four-day hospitalization, he was discharged home with a diagnosis of acute pericarditis. Because of worsening symptoms with acute respiratory failure and newly developed lymphadenopathies, he was readmitted a few days later and diagnosed with nosocomial pneumonia. Despite treatment with broad-spectrum antibiotics, his condition worsened, necessitating mechanical ventilation and VV-ECMO to manage refractory hypoxemia. Subsequent investigation revealed the diagnosis of ALK-positive anaplastic large cell lymphoma with pulmonary involvement. Treatment with cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisolone (CHOEP) chemotherapy led to significant clinical improvement, allowing successful VV-ECMO weaning. However, the disease relapsed shortly after with a comparable severity of respiratory failure, leading to a second VV-ECMO run combined with urgent BRESHAP (brentuximab vedotin, etoposide, methylprednisolone (Solu-Medrol), high-dose cytarabine (Ara-C), and cisplatin) chemotherapy. This strategy resulted in another successful VV-ECMO weaning. Although complete remission was achieved, stem cell transplantation was delayed due to pulmonary sequelae, and the patient declined further treatment. A second relapse occurred, and the patient died 12 months after diagnosis. This case report explores the potential utility of VV-ECMO as a bridge to recovery in carefully selected patients with treatable hematologic malignancies.