Lymphomatous Meningitis From Anaplastic Lymphoma Kinase+ Anaplastic Large T-Cell Lymphoma Treated With Lorlatinib: A Case Report

摘要

Background: Anaplastic large cell lymphoma (ALCL) accounts for approximately 2% of adult non-Hodgkin lymphoma, and is the second or third most common lymphoma with T-cell histology in adults. According to the revised 2016 WHO classification, four distinct entities of ALCL are currently recognized: (1) ALCL, anaplastic lymphoma kinase (ALK)+ (2) ALCL, ALK-, (3) primary cutaneous ALCL, and (4) breast implant-associated ALCL. All cases of ALK+ ALCL have a rearrangement in the ALK gene located on chromosome 2p23. The t (2;5) translocation yields an abundantly expressed chimeric protein containing the oligomerization motif of nucleophosmin 1 and the kinase domain of ALK. The nucleophosmin-ALK homodimer cross-phosphorylates itself, leading to persistent kinase activation. On the basis of this additional genetic evidence, the WHO recognized ALK+ ALCL in 2008. Typical features of most ALCL tumors include the presence of hallmark cells, which are large cells with kidney-shaped nuclei and a perinuclear eosinophilic region, along with the universal expression of the CD30 antigen.