Annals of Hematology

, Volume 97, Issue 1, pp 193–196 | Cite as

PD1 blockade with low-dose nivolumab in NK/T cell lymphoma failing l-asparaginase: efficacy and safety

  • Thomas S. Y. Chan
  • Jamilla Li
  • Florence Loong
  • Pek-Lan Khong
  • Eric Tse
  • Yok-Lam KwongEmail author
Letter to the Editor

Dear Editor,

Extranodal natural killer (NK)/T cell lymphoma is an aggressive malignancy. Effective regimens for this lymphoma contain l-asparaginase. For patients failing l-asparaginase-containing regimens, there are no useful conventional salvage approaches [1]. We recently reported that blockade of programmed cell death protein 1 (PD1) on effector T cells with the anti-PD1 antibody pembrolizumab was highly efficacious in NK/T cell lymphoma failing l-asparaginase [2].

Anti-PD1 antibodies are off-label non-reimbursed drugs for NK/T cell lymphomas. Not every patient can afford pembrolizumab. Since employing PD1 blockade as an option for NK/T cell lymphomas failing l-asparaginase, we have with informed consent treated three patients who could only afford another anti-PD1 antibody nivolumab, which if given at 40 mg (the smallest vial available) every 2 weeks (Q2W) was much cheaper than pembrolizumab.

Patient 1 was a 59-year-old man with stage IV disease involving the nasal cavity, right...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Tse E, Kwong YL (2017) The diagnosis and management of NK/T-cell lymphomas. J Hematol Oncol 10(1):85CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kwong YL, Chan TSY, Tan D, Kim SJ, Poon LM, Mow B, Khong PL, Loong F, Au-Yeung R, Iqbal J, Phipps C, Tse E (2017) PD1 blockade with pembrolizumab is highly effective in relapsed or refractory NK/T-cell lymphoma failing l-asparaginase. Blood 129(17):2437–2442CrossRefPubMedGoogle Scholar
  3. 3.
    Lee DW, Gardner R, Porter DL, Louis CU, Ahmed N, Jensen M, Grupp SA, Mackall CL (2014) Current concepts in the diagnosis and management of cytokine release syndrome. Blood 124(2):188–195CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Hwang YY, Khong PL, Kwong YL (2017) Low-dose nivolumab induced remission in refractory classical Hodgkin lymphoma. Ann Hematol 96(7):1219–1220CrossRefPubMedGoogle Scholar
  5. 5.
    Chan TSY, Sim JPY, Kwong YL (2017). Low-dose nivolumab-induced responses in acute lymphoblastic leukaemia relapse after allogeneic haematopoietic stem cell transplantation. Ann Hematol, Jun 1 [Epub ahead of print]Google Scholar
  6. 6.
    Zhao X, Suryawanshi S, Hruska M, Feng Y, Wang X, Shen J, Vezina HE, McHenry MB, Waxman IM, Achanta A, Bello A, Roy A, Agrawal S (2017). Assessment of nivolumab benefit-risk profile of a 240-mg flat dose relative to a 3-mg/kg dosing regimen in patients with advanced tumors. Ann Oncol, May 17 [Epub ahead of print]Google Scholar
  7. 7.
    Champiat S, Lambotte O, Barreau E, Belkhir R, Berdelou A, Carbonnel F, Cauquil C, Chanson P, Collins M, Durrbach A, Ederhy S, Feuillet S, François H, Lazarovici J, Le Pavec J, De Martin E, Mateus C, Michot JM, Samuel D, Soria JC, Robert C, Eggermont A, Marabelle A (2016) Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper. Ann Oncol 27(4):559–574CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of MedicineProfessorial Block, Queen Mary HospitalHong KongChina
  2. 2.Department of PathologyQueen Mary HospitalHong KongChina
  3. 3.Department of Diagnostic RadiologyQueen Mary HospitalHong KongChina

Personalised recommendations