Transient atelectasis due to hilar lymph node swelling affected bylenalidomide-induced tumor flare reaction

摘要

Tumor flare reaction (TFR) is a unique immune-mediated tumor recognition phenomenonpresenting as rapid enlargement of the tumor, which mimics disease progression, developingin the early stage of treatment using immunomodulatory drugs or immune checkpointinhibitors. A 59-year-old man with follicular lymphoma had residual tumor burden in theleft hilar lymph nodes after R-CHOP therapy, and received lenalidomide and rituximab(R2) therapy. He developed respiratory distress on day 11 of R2therapy. Chest X-ray and CT demonstrated left lung atelectasis due to left hilar lymphnode swelling. We performed transbronchial lung biopsy on day 20 of R2 therapy.The biopsied left bronchus tissue exhibited extensive necrosis, which had a B-cellphenotype consistent with that of follicular lymphoma. Neither NK cells nor cytotoxic Tcells were detected. It was unclear whether the immune effector cells disappeared at thetime of transbronchial lung biopsy. Atelectasis in our patient improved by continuingR2 therapy beyond TFR.