Successful treatment with EPOCH followed by mogamulizumab for angioimmunoblastic T-cell lymphoma with myelofibrosis and pure red cell aplasia

The patient was a 70-year-old woman. She visited a doctor for sore throat, facial edema, and lymphadenopathy. Lymph node biopsy was performed, and led to a diagnosis of AITL. When the patient was admitted to our department for treatment, she had severe anemia with Hb 4.2 g/dl, and bone marrow aspiration resulted in a dry tap. Bone marrow biopsy revealed infiltration of tumor cells, a severe decrease in erythroblastic cells, and bone marrow fibrosis. Although lymph node size was reduced by THP-COP, bone marrow biopsy showed residual infiltration of tumor cells. In addition, since low reticulocyte counts and anemia persisted, weekly red blood cell transfusions were required. Therefore, the treatment regimen was changed to EPOCH. After two cycles of EPOCH, anemia improved, and red cell transfusions were no longer required. Bone marrow examination after four cycles showed disappearance of lymphoma cells and no evidence of bone marrow fibrosis or erythroblasts. However, due to residual bone marrow infiltration of lymphoma cells, treatment with mogamulizumab was started. Complete remission was maintained for five years. This indicates that EPOCH and mogamulizumab are treatment options for AITL patients with bone marrow involvement, PRCA, and myelofibrosis.