Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy that can manifest with skin nodules and erythematous plaques. In most cases BPDCN progresses rapidly, causing multiple skin lesions and also affecting internal organs and bone marrow, warranting initiation of systemic therapies or hematopoietic stem cell transplantation (HCT). Although not curative, radiotherapy for isolated lesions might be indicated in case of (imminent) ulceration and large or symptomatic lesions. To this end, doses of 27.0–51.0 Gy have been reported. Here, we present the case of an 80-year-old male with BPDCN with multiple large, nodular, and ulcerating lesions of the thorax, abdomen, and face. Low-dose radiotherapy of 2 × 4.0 Gy was administered to several lesions, which resolved completely within 1 week with only light residual hyperpigmentation of the skin in affected areas and reliably prevented further ulceration. Radiotoxicity was not reported. Therefore, low-dose radiotherapy can be an effective and low-key treatment in selected cases of BPDCN, especially in a palliative setting, with a favorable toxicity profile.
Introduction
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy arising from precursor plasmacytoid dendritic cells [1, 2]. Multiple nodular and sometimes ulcerating skin lesions which can encompass the whole integument [3] are often the first manifestation. Internal organs, the lymphatic system, and bone marrow can also be affected [2, 4,5,6]. In a palliative setting, extensive skin lesions can cause significant symptomatic strain for patients and favorable results of local radiotherapy have been reported. So far, the literature on this disease entity reports higher radiation doses to the skin of up to 51.0 Gy in 3.0 Gy per fraction, corresponding to several weeks of treatment time. Here, we report a patient with a complete and lasting response to a short and hypofractionated electron radiotherapy dose of 8.0 Gy in 4.0 Gy per fraction, resulting in a significantly shorter treatment time in a palliative setting.
Case report
An 80-year-old male with BPDCN with nodular, indolent cutaneous lesions of the thorax, abdomen, and face was referred to our department. He reported a history of chronic myelomonocytic leukemia (CMML) which had been diagnosed 18 years previously and for which a watch-and-wait strategy had been adopted. Associated BPDCN was histologically confirmed as indolent skin lesions surfaced on the back and right temple (Figure 1 and 2). Dermal histopathology described diffuse infiltration of blast cells with increased mitotic activity (Ki67 60–70%). Atypical lymphoid cells showed positive expression of Bcl-2, CD56, CD123, and, to a lesser extent, CD4. No expression of CD3, CD20, CD30, or MPO was found, confirming the diagnosis of BPDCN skin involvement. Bone marrow analysis at the time of diagnosis showed accelerated CMML with an increased blastic fraction (7.5%), but no infiltration of BPDCN. A CT scan yielded splenomegaly and lymphadenopathy without involvement of internal organs. As BPDCN has been reported secondary to CMML, systemic therapy with six cycles of azacitidine, an analogue of cytidine, was initiated. Under azacitidine treatment, the CMML responded well with normalization of thrombocyte and monocytic cell count, but BPDCN lesions progressed. Therefore, targeted therapy with tagraxofusp, a fusion antibody binding interleukin 3 (IL-3), was initiated. However, treatment was discontinued after two cycles as BPDCN lesions showed further progression and treatment with hydroxyurea was initiated. At this point, multiple skin lesions developed, affecting mainly the face, thorax, and abdomen, and the patient was referred to our department. Laboratory findings showed a leukocyte count of 4480/µl, with an increased monocyte count (36.4%) of atypical immature monocytes and a reduction in neutrophils (18.5%). Thrombocyte counts were within the normal range (161,000/µl). Hemoglobin was 11.7 g/dl and both rouleaux and acanthocytes were found. Radiotherapy was considered because of ulceration and secretion of both a preauricular skin nodule measuring 50 × 40 mm and two rapidly progressing dorsal thoracic lesions bothering the patient. All three superficial lesions were treated with electron beams (the facial nodule with 8 MeV and the others with 6 MeV), delivered in 2 × 4.0 Gy and a 10-mm bolus on subsequent days (for a detailed description, please refer to Table 1). Within 7 days, ulcerations had healed and skin protuberance of the lesions had resolved, showing only slight erythematous maculae of the skin (Figure 1 and 2). Secretion had ceased completely. No radiation-associated toxicities were reported. The patient expressed his satisfaction with the outcome yielded by radiotherapy. Therefore, four further thoracic lesions were also treated with 8 MeV in 2 × 4.0 Gy to prevent ulceration following initial radiotherapy (Table 1). Here, an equally good response at 1 and 4 weeks after radiotherapy could be observed. Under treatment with hydroxyurea, non-irradiated lesions did not respond. Ultimately, venetoclax was started due to systemic progression of BPDCN with bone marrow affectation. However, bone marrow affectation progressed after 1 month despite venetoclax treatment, with the patient developing pancytopenia, gastric hemorrhage, and cerebral symptoms in the form of progressive confusion. According to the patient’s wishes, best supportive care was initiated following his discharge from hospital. Up to discharge from our hospital, irradiated lesions showed a durable response.
Discussion
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematological neoplasm characterized by CD123+ (IL‑3 receptor) expression and at least one plasmacytoid dendritic cell marker in addition to expression of CD4+ and CD56+. Other markers that consistently show positive staining include CD43, CD45, and Bcl-2 (as in our case), CD2AP, and markers associated with plasmacytoid dendritic cell origin like HLA-DR, CD303+, CD304+, and cTCL1+. Negative staining is found for CD3, CD14, CD19, PAX5, lysozyme, myeloperoxidase, and CD34 [15] according to the current WHO classification 2022 [1]. Typically, a high Ki-67 proliferation index is found. In case of skin involvement, infiltration of the dermis and subcutis by immature blastoid neoplastic cells is observed in dermal histology. In 10–20% of cases, it is associated with other hematologic neoplasms, and can arise from myeloid neoplasms like CMML and acute myeloid leukemia (AML) [16,17,18]. Systemic therapy in patients with good performance status encompasses regimens analogous to induction therapy in acute leukemia (such as ALL/LBL or AML protocols) and a moderate intense non-Hodgkin lymphoma regimen (like cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP]) [8, 10, 19]. A meta-analysis published by Bruch et al. provided evidence for the combination of allogenic stem cell transplantation after myeloablative conditioning with total body irradiation in a curative setting [9]. reporting improvement in both overall and progression-free survival. However, as BPDCN with a median age at onset of 65 years mostly affects elderly patients, many are not eligible for the intense polychemotherapy regimens needed for curative treatment, so less intense regimens or monotherapies are chosen. Due to the rarity of BPDCN, no specific recommendation can be made, but there is evidence for a number of substances including etoposide, hydroxyurea, and azacitidine [5, 20]. Newer and targeted treatment options include tagraxofusp [21,22,23,24], which selectively binds the IL‑3 receptor which is expressed abundantly in BPDCN [25], and venetoclax, an oral Bcl‑2 inhibitor, approved for chronic lymphocytic leukemia [6, 7, 26, 27]. Although initial response to systemic treatment is usually good, BPDCN shows a tendency for early relapses, associated with a dismal prognosis with a 2-year survival rate below 20% and thus the need for palliative treatment options.
Literature on radiotherapy in BPDCN is scarce, with only few reports detailing radiotherapy regimens, regardless of curative or palliative settings. In our literature review, we identified 19 publications with which reported on local radiotherapy as the only or part of the first-line treatment in 47 patients with cutaneous BPDCN lesions (Table 2; [11, 13, 14, 28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]). With the exception of five patients aged 23, 32, 36, 38 and 43 years, the age range was 59–90 years, corresponding to the median age of onset of 65 years. As this older patient cohort is often not eligible for high-dose chemotherapy, in most cases radiotherapy was chosen as the only first-line treatment or as a complement to intensity-reduced chemotherapy regimens. The gender ratio was 20 male to 10 female patients; however, gender was not reported in all publications. Likewise, most publications did not detail dose, set-up, or target volume for local radiotherapy. The most detailed publication dedicated to radiotherapy dose and delivery in BPDCN is by Ishibashi et al. [11], who reported treatment of a patient with several skin nodules who had declined chemotherapy. In their case, the patient was treated with 30 Gy in 10 fractions using electron beam irradiation to an isolated painful lesion on the left forearm, with a good response of the irradiated but progression of the non-irradiated lesions. All other publications also describe favorable responses to radiotherapy, with an at least transient partial or complete response of irradiated cutaneous nodules. Of the few publications giving detail on radiation protocols, one reported a cumulative dose of 27.0 in single fractions of 3.0 Gy [14], to which a complete response could initially be observed. However, relapse occurred 2 months after radiation treatment. In a case report by Fontaine et al., the patient received 40 Gy in combination with methotrexate and L‑asparaginase, resulting in a complete response and the patient being alive 30 months after treatment completion [30], and Amitay-Laish describe 2 patients who showed a complete and lasting response to consolidative radiotherapy with 36 Gy [43]. In those cases, however, high-dose chemotherapy was applied as the patients were aged 38 and 23 years old. A similar good result was attained in the case of a 32-year-old male who also received consolidative radiotherapy with 36 Gy after CHOEP-14 [41]. In two other reports where comparable doses were chosen—34 Gy and two patients receiving 40 Gy—in combination with chemotherapy, however, only a partial response with rapid systemic progression and a relapse-free survival of less than 12 months, respectively, could be observed [40, 42]. It is noteworthy that lasting remissions could be attained in younger patients, probably corresponding to an eligibility for high-dose chemotherapy regimens and stem cell transplantation, but possibly also due to a different tumor biology in younger patients. Three publications describe higher cumulative doses of 50.0–51.0 Gy [32, 37, 39]. In all of these cases, an initial complete response could be attained. However, only in one case, reported by Higgins et al., did radiotherapy as the only treatment lead to long-term disease remission [39]. In the two other patients, death from systemic progression occurred at 9 months and 25 months, respectively, after radiotherapy [37, 39]. In cases in which radiotherapy doses were not detailed, mixed responses to radiotherapy were reported. In general, local radiotherapy led to a partial or complete remission of irradiated lesions, but most patients showed (systemic) progression, with a range of relapse-free survival of 2–31 months (Table 2). Even in an early stage of the disease where only dermal involvement is found, higher doses to single or singular lesions did not consistently lead to lasting remission or prevent systemic progression [32, 37]. It might be hypothesized that the combination of local radiotherapy with chemotherapy might lead to longer remission [35], especially in younger patients [43]. However, not all patients receiving additional chemotherapy showed longer remission [29, 31] and the presented data are not reliable enough to make a recommendation for combination therapy, especially as crucial details on radiation dose and toxicity profile are missing in most reports and heterogenous systemic therapies were applied. Nevertheless, as older and frail patients are often not suitable for high-dose chemotherapy, higher radiation doses in cases of single dermal lesions without systemic involvement might provide a suitable treatment option—either as single therapy or in combination with dose-reduced chemotherapy regimens—to provide local control with limited toxicity and prolong relapse-free survival in this patient clientele.
In a palliative setting, such as in our case, the benefit of a higher radiation dose should be weighed against the comparatively long treatment time of up to over 3 weeks [12,13,14, 30], as longer treatment time and trips to the hospital can cause strain for patients. Moreover, in our case, systemic disease occurred before skin lesions, which developed after systemic therapy had already been initiated. The patient had only been referred to us in the described advanced stage of the disease and with multiple lesions, contributing to our choice of a hypofractionated treatment regimen.
This choice was corroborated by evidence regarding the effect of low-dose radiotherapy in other hematological malignancies such as indolent B‑cell lymphoma or chloroma and leukemia cutis, which showed a high sensitivity to even low doses. The randomized FORT trial compared the effect of 4 Gy in two fractions to 24 Gy in 12 fractions in patients with early- and advanced-stage follicular and marginal zone lymphoma [44]. Here, local control was significantly better in all subgroups when 24 Gy was applied, but overall survival and time to progression did not differ between the standard and low-dose treatment group. As toxicity such as mucositis, pain in the irradiated area, and fatigue were significantly higher in the 24-Gy group, low-dose radiotherapy could offer a short and well-tolerated treatment in palliative cases. Furthermore, if needed, re-irradiation would be feasible after 4 Gy in most cases. In case of chloroma lesions, Oertel et al. found a complete response to doses < 10 Gy and > 10 Gy/< 20 Gy in 75 and 83%, respectively [45]. Several publications report a favorable response of leukemia cutis to comparable low doses of radiotherapy, delivered either as whole-skin electron beam or focal radiotherapy [45,46,47]. In a consensus statement, Bakst et al. recommend doses of 24 Gy for chloroma and leukemia cutis, with cumulative doses of as low as 6 Gy in clinical settings which call for a short total treatment time [48]. In mycosis fungoides, good local control was attained by ultrahypofractionated whole-skin electron beam irradiation with 8 Gy in two fractions, resulting in a shorter treatment time and less toxicity [49, 50]. In patients with diffuse/multiple skin manifestations, total skin electron beam therapy may be required to cover the involved sites [51]. The reported publications are in line with our choice of dose and fractionation, as in our case, too, skin lesions were symptoms of an underlying systemic and generalized hematological malignancy.
More generally, a recent review on application of radiotherapy in lymphoma also supports low-dose and (ultra)hypofractionated treatment regimens in frail and palliative patients [52]. Furthermore, apart from a marked sensitivity of hematological malignancies to radiotherapy, implementing (low-dose) radiotherapy in treatment regimens involving immunotherapy and/or CAR‑T cell therapies might improve treatment by causing a priming effect in the antitumor immune system response. Radiation has been shown to result in immunogenic cell death, thereby facilitating tumor antigen release and boosting the antitumor immune response [53,54,55]. However, more research is needed to determine the sequence, dose, and timing needed to attain optimal results regarding the combination of systemic therapy and radiation in hematologic malignancies with skin manifestation.
In the case of the patient reported here, a short treatment concept was chosen deliberately in line with the presented data on low-dose and hypofractionated therapies in a palliative setting as the patient was treated as an outpatient with a long traveling distance to the hospital. Also, he presented with multiple lesions and systemic involvement, for which he already received hydroxyurea. Irradiated lesions responded swiftly to a comparatively low total dose of 8 Gy without reported radiation toxicity, corroborating the chosen short hypofractionated radiotherapy concept in the presented setting.
Conclusion
Herein, we report a good and satisfactory clinical response of BPDCN skin lesions to a short hypofractionated radiotherapy with 2 × 4.0 Gy without observed toxicity. In a palliative setting, this compares favorably with regard to treatment time and attained results to published radiotherapy regimens reporting much higher doses of 27.0–51.0 Gy and a total treatment time of up to 3 weeks. Thus, palliative low-dose hypofractionated radiotherapy can serve as a viable treatment option in patients ineligible for stem cell transplantation in advanced stages of the disease, alleviating associated symptoms while minimizing the strain of treatment.
References
Khoury JD et al (2022) The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms. Leukemia 36(7):1703–1719
Laribi K et al (2016) Blastic Plasmacytoid Dendritic Cell Neoplasm: From Origin of the Cell to Targeted Therapies. Biol Blood Marrow Transplant 22(8):1357–1367
Cui XB et al (2014) A case of blastic plasmacytoid dendritic cell neoplasm with ecchymotic lesions on the whole body. Int J Clin Exp Pathol 7(7):4391–4399
Borchiellini D et al (2013) Blastic plasmacytoid dendritic cell neoplasm: a report of four cases and review of the literature. J Eur Acad Dermatol Venereol 27(9):1176–1181
Laribi K et al (2014) Blastic plasmacytoid dendritic cell neoplasm: the first report of two cases treated by 5‑azacytidine. Eur J Haematol 93(1):81–85
Sapienza MR et al (2019) Blastic Plasmacytoid Dendritic Cell Neoplasm: State of the Art and Prospects. Cancers (basel) 11(5)
Economides MP, Konopleva M, Pemmaraju N (2019) Recent developments in the treatment of blastic plasmacytoid dendritic cell neoplasm. Ther Adv Hematol 10:2040620719874733
Laribi K et al (2020) Blastic plasmacytoid dendritic cell neoplasms: results of an international survey on 398 adult patients. Blood Adv 4(19):4838–4848
Bruch PM et al (2022) Retrospective analysis of hematopoietic cell transplantation for blastic plasmacytoid dendritic cell neoplasm: conditioning intensity matters. Leukemia
Poussard M, Angelot-Delettre F, Deconinck E (2022) Conventional Therapeutics in BPDCN Patients—Do They Still Have a Place in the Era of Targeted Therapies? Cancers (basel) 14(15)
Ishibashi N et al (2015) Radiation therapy for cutaneous blastic plasmacytoid dendritic cell neoplasm: a case report and review of the literature. Int J Clin Exp Med 8(5):8204–8209
An HJ et al (2013) Blastic plasmacytoid dendritic cell neoplasm: a single-center experience. Ann Hematol 92(3):351–356
Xue R et al (2010) A case of cutaneous blastic plasmacytoid dendritic cell neoplasm. Acta Derm Venereol 90(6):645–646
Tsunoda K et al (2012) Blastic plasmacytoid dendritic cell neoplasm : report of two cases. J Clin Exp Hematop 52(1):23–29
Arber DA et al (2016) The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 127(20):2391–2405
Lucas N et al (2019) Biology and prognostic impact of clonal plasmacytoid dendritic cells in chronic myelomonocytic leukemia. Leukemia 33(10):2466–2480
Zalmai L et al (2021) Plasmacytoid dendritic cells proliferation associated with acute myeloid leukemia: phenotype profile and mutation landscape. Haematologica 106(12):3056–3066
Xiao W et al (2021) Plasmacytoid dendritic cell expansion defines a distinct subset of RUNX1-mutated acute myeloid leukemia. Blood 137(10):1377–1391
Sullivan JM, Rizzieri DA (2016) Treatment of blastic plasmacytoid dendritic cell neoplasm. Hematology Am Soc Hematol Educ Program 2016(1):16–23
Le Calloch R et al (2022) Achievement of rapid complete remission in an 87-year-old female patient with azacytidine-venetoclax for blastic plasmacytoid dendritic cell neoplasm. Ann Hematol 101(6):1347–1349
Hammond D, Pemmaraju N (2020) Tagraxofusp for Blastic Plasmacytoid Dendritic Cell Neoplasm. Hematol Oncol Clin North Am 34(3):565–574
Alfayez M, Konopleva M, Pemmaraju N (2020) Role of tagraxofusp in treating blastic plasmacytoid dendritic cell neoplasm (BPDCN). Expert Opin Biol Ther 20(2):115–123
Pemmaraju N, Konopleva M (2020) Approval of tagraxofusp-erzs for blastic plasmacytoid dendritic cell neoplasm. Blood Adv 4(16):4020–4027
Lee SS, McCue D, Pemmaraju N (2020) Tagraxofusp as treatment for patients with blastic plasmacytoid dendritic cell neoplasm. Expert Rev Anticancer Ther 20(7):543–550
Cai T et al (2022) Targeting CD123 in blastic plasmacytoid dendritic cell neoplasm using allogeneic anti-CD123 CAR T cells. Nat Commun 13(1):2228
Jones JA et al (2018) Venetoclax for chronic lymphocytic leukaemia progressing after ibrutinib: an interim analysis of a multicentre, open-label, phase 2 trial. Lancet Oncol 19(1):65–75
Davids MS et al (2018) Comprehensive Safety Analysis of Venetoclax Monotherapy for Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia. Clin Cancer Res 24(18):4371–4379
Bekkenk MW et al (2004) CD56+ hematological neoplasms presenting in the skin: a retrospective analysis of 23 new cases and 130 cases from the literature. Ann Oncol 15(7):1097–1108
Petrella, T., et al., Blastic NK-cell lymphomas (agranular CD4+CD56+ hematodermic neoplasms): a review. Am J Clin Pathol, 2005. 123(5): p. 662–75.
Fontaine J et al (2009) Haematodermic CD4+CD56+ neoplasm: complete remission after methotrexate-asparaginase treatment. Clin Exp Dermatol 34(5):e43–5
Dalle S et al (2010) Blastic plasmacytoid dendritic cell neoplasm: is transplantation the treatment of choice? Br J Dermatol 162(1):74–79
Miyashita A (2011) A case of CD4+/CD56+ hematodermic neoplasm treated with electron beam irradiation. Ski Cancer 26:31–35
Pileri A et al (2012) Blastic plasmacytoid dendritic cell neoplasm (BPDCN): the cutaneous sanctuary. G Ital Dermatol Venereol 147(6):603–608
Hashikawa K et al (2012) Clinicopathological features and prognostic significance of CXCL12 in blastic plasmacytoid dendritic cell neoplasm. J Am Acad Dermatol 66(2):278–291
Sugimoto KJ et al (2013) Sustained complete remission of a limited-stage blastic plasmacytoid dendritic cell neoplasm followed by a simultaneous combination of low-dose DeVIC therapy and radiation therapy: a case report and review of the literature. Int J Clin Exp Pathol 6(11):2603–2608
Pagano L et al (2013) Blastic plasmacytoid dendritic cell neoplasm with leukemic presentation: an Italian multicenter study. Haematologica 98(2):239–246
Yu G et al (2015) Blastic plasmacytoid dendritic cell neoplasm presenting with a cutaneous tumor alone as the first symptom of onset: A case report and review of literature. Oncol Lett 9(2):819–821
Bruggen MC et al (2020) Clinical diversity and treatment approaches to blastic plasmacytoid dendritic cell neoplasm: a retrospective multicentre study. J Eur Acad Dermatol Venereol 34(7):1489–1495
Higgins MJ et al (2022) Unifocal cutaneous blastic plasmacytoid dendritic cell neoplasm with a favorable response following high-dose radiotherapy alone. Leuk Lymphoma 63(12):3004–3007
Kaune KM et al (2009) Solitary cutaneous nodule of blastic plasmacytoid dendritic cell neoplasm progressing to overt leukemia cutis after chemotherapy: immunohistology and FISH analysis confirmed the diagnosis. Am J Dermatopathol 31(7):695–701
Dohm A et al (2011) Progression of a CD4+/CD56+ blastic plasmacytoid DC neoplasm after initiation of extracorporeal photopheresis in an allogeneic transplant recipient. Bone Marrow Transplant 46(6):899–900
Heinicke T et al (2015) Sustained remission of blastic plasmacytoid dendritic cell neoplasm after unrelated allogeneic stem cell transplantation—a single center experience. Ann Hematol 94(2):283–287
Amitay-Laish I et al (2017) Localized skin-limited blastic plasmacytoid dendritic cell neoplasm: A subset with possible durable remission without transplantation. JAAD Case Rep 3(4):310–315
Hoskin PJ et al (2014) 4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): a randomised phase 3 non-inferiority trial. Lancet Oncol 15(4):457–463
Oertel M et al (2018) Radiotherapy for extramedullary leukaemic manifestation (Chloroma). Strahlenther Onkol 194(2):164–173
Bakst R, Yahalom J (2011) Radiation therapy for leukemia cutis. Pract Radiat Oncol 1(3):182–187
Elsayad K et al (2017) The effectiveness of radiotherapy for leukemia cutis. J Cancer Res Clin Oncol 143(5):851–859
Bakst RL et al (2018) Use of Radiation in Extramedullary Leukemia/Chloroma: Guidelines From the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 102(2):314–319
Elsayad K, Eich HT (2023) The evolving role of reduced-dose total skin electron beam therapy in skin malignancies: the renaissance of a rare indication. Strahlenther Onkol 199(10):950–953
Elsayad K et al (2023) Ultrahypofractionated Low-Dose Total Skin Electron Beam in Advanced-Stage Mycosis Fungoides and Sezary Syndrome. Int J Radiat Oncol Biol Phys 117(1):164–170
Elsayad K, Eich H.T (2023) The evolving role of reduced-dose total skin electron beam therapy in skin malignancies: the renaissance of a rare indication. Strahlenther Onkol 199, 950–953 https://doi.org/10.1007/s00066-023-02115-4
Specht L (2023) Reappraisal of the role of radiation therapy in lymphoma treatment. Hematol Oncol 41(Suppl 1: p):75–81
Wu SY et al (2023) Safety of Concurrent Radiation Therapy With Brentuximab Vedotin in the Treatment of Lymphoma. Adv Radiat Oncol 8(6):101279
Dabaja B, Spiotto M (2023) Radiation for hematologic malignancies: from cell killing to immune cell priming. Front Oncol 13:1205836
Kahn JM et al (2023) Assessment of Lymphoma and Other Hematologic Malignancies Training Needs Among Radiation Oncology Residents: a Brief Report. J Cancer Educ 38(1):201–205
Funding
Open Access funding enabled and organized by Projekt DEAL.
Author information
Authors and Affiliations
Contributions
EH, SB, CDC, and CG attended to the clinical care of the patient. EH performed the literature review and wrote the manuscript. SB, CDC, CL, MN, and CG gave advice on the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
E. Hoffmann, S. Böke, C. De-Colle, C. Lengerke, K.-M. Niyazi, and C. Gani declare that they have no competing interests.
Ethical standards
The patient gave written consent to analysis and anonymized publication of his data.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Hoffmann, E., Böke, S., De-Colle, C. et al. Ulcerating skin lesions from blastic plasmacytoid dendritic cell neoplasm responding to low-dose radiotherapy—a case report and literature review. Strahlenther Onkol (2024). https://doi.org/10.1007/s00066-024-02200-2
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00066-024-02200-2