Lenalidomide and Carfilzomib in Relapsed and Refractory T Follicular Helper Lymphomas

Non-Hodgkin T-cell lymphomas represent a heterogeneous group of aggressive haematological malignancies with a high risk of early relapse or resistance to standard treatment protocols. One significant drawback is that chemotherapy protocols were initially designed for B-cell lymphomas, and targeted studies for T-cell lymphomas were only recently developed. Due to the rising incidence of peripheral T cell lymphomas (PTCL) in recent years, there is a need for new therapies to effectively treat these types of malignancies. Incorporating gene expression profile (GEP) studies in the standard diagnostic tests could enable treatments specifically tailored to each patient's needs. In this article we present the case of a patient diagnosed nodal-T follicular helper cell lymphoma, who exhibited early relapse following the standard chemotherapy protocol in our country. After multiple lines of treatment without favorable response, we conducted an off-label treatment combining Lenalidomide (an immunomodulatory drug) and Carfilzomib (a selective irreversible proteasome inhibitor). This therapeutic approach was previously done in other studies, but it involved also the use of Romidepsin, a histone deacetylase inhibitor (HDACi). We did not use Romidepsin in this patient as it is not approved in the European Union for patients with PTCL.