A Modern Approach to T-Cell Lymphoma Treatment: Demonstrating a Therapeutic Strategy (A clinical case)

Abstract

Relevance: Primary lymphomas of the central nervous system (CNS) are a rare type of lymphoma, accounting for 2% of all CNS lymphomas and are associated with a poor prognosis. According to the data from the EROB Information System in the Republic of Kazakhstan (RK), in 2023–2024, the diagnosis of «CNS lymphoma» was morphologically confirmed in 13 individuals. Among primary CNS lymphomas, ALK-negative anaplastic large T-cell lymphoma of the CNS is a highly malignant tumor with an aggressive clinical course. Treatment approaches for such patients remain unresolved, necessitating an expansion of the evidence base and more clinical observations.

Objective: To demonstrate, through a clinical case and literature review, the effectiveness of combined chemotargeted therapy in conjunction with autologous bone marrow transplantation in a patient with ALK-negative anaplastic large-cell lymphoma of the CNS -T-cell lymphoma subtype.

Methods: This article describes a clinical case of a patient with T-cell lymphoma of the CNS. Diagnostic data including computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI) of the brain, as well as histopathological examination with immunohistochemical analysis of postoperative material, are presented. Disease progression and treatment response are discussed.

Results: The patient was initially diagnosed with primary anaplastic lymphoma of the CNS, ALK-negative subtype, following microsurgical tumor removal. Given the rarity of the disease variant and tumor localization, a histopathological review with immunohistochemical analysis of the postoperative specimens was performed, leading to a treatment strategy that included the targeted agent brentuximab vedotin. This case illustrates the potential for combined chemotargeted therapy in treating ALK-negative anaplastic lymphoma of the CNS, taking into account the tumor’s biological characteristics and patient-specific factors.

Conclusion: Choosing the correct treatment strategy depends on establishing an accurate and timely diagnosis, making diagnostics a key component in patient management algorithms. Therefore, morphological and immunohistochemical studies are essential. To improve prognosis and survival outcomes for such patients, recent strategies favor the development and application of combined therapeutic approaches, including intensive chemotherapy regimens alongside modern targeted therapies.