Rapid progression of adult T-cell leukemia/lymphoma as tumor-infiltrating Tregs after PD-1 blockade

Daniel A. Rauch, Kevin C. Conlon, Murali Janakiram, Jonathan E. Brammer, John C. Harding, B. Hilda Ye, Xingxing Zang, Xiaoxin Ren, Sydney Olson, Xiaogang Cheng, Milos D. Miljkovic, Hemalatha Sundaramoorthi, Ancy Joseph, Zachary L. Skidmore, Obi Griffith, Malachi Griffith, Thomas A. Waldmann, Lee Ratner

Research output: Contribution to journalArticlepeer-review

83 Scopus citations


Immune checkpoint inhibitors are a powerful new tool in the treatment of cancer, with prolonged responses in multiple diseases, including hematologic malignancies, such as Hodgkin lymphoma. However, in a recent report, we demonstrated that the PD-1 inhibitor nivolumab led to rapid progression in patients with adult T-cell leukemia/lymphoma (ATLL) (NCT02631746). We obtained primary cells from these patients to determine the cause of this hyperprogression. Analyses of clonality, somatic mutations, and gene expression in the malignant cells confirmed the report of rapid clonal expansion after PD-1 blockade in these patients, revealed a previously unappreciated origin of these malignant cells, identified a novel connection between ATLL cells and tumor-resident regulatory T cells (Tregs), and exposed a tumor-suppressive role for PD-1 in ATLL. Identifying the mechanisms driving this alarming outcome in nivolumab-treated ATLL may be broadly informative for the growing problem of rapid progression with immune checkpoint therapies.

Original languageEnglish (US)
Pages (from-to)1406-1414
Number of pages9
Issue number17
StatePublished - Oct 24 2019

Bibliographical note

Funding Information:
This work was supported by Public Health Service grants UM1 186707, CA23460, CA063417, CA100730, CA016672, and HG007940; funds from the Siteman Cancer Center and intramural National Cancer Institute Program; and a grant from the Dr. Louis Skarlow Memorial Trust (B.H.Y.).

Publisher Copyright:
© 2019 American Society of Hematology. All rights reserved.


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