A case of primary cutaneous natural killer/T‐cell lymphoma, nasal type, with indolent clinical course: monoclonal expansion of Epstein–Barr virus genome correlating with the terminal aggressive behaviour

trate of T lymphocytes and neutrophils plays a significant pathophysiological role. It is, therefore, not surprising that TNF-a inhibitors are effective in downregulating this process to achieve disease remission. Our three patients had a dramatic and sustained response to adalimumab. Two of the three had failed previous treatment with other biologic therapies, showing that adalimumab can be effective in ACH where other biologics have failed. Adalimumab was well tolerated. One patient developed metastatic lung cancer but it is unclear what role, if any, the drug played. Although it is possible that 5 years of anti-TNF-a treatment with infliximab, etanercept and adalimumab and a multitude of prior immunosuppressive agents contributed to the development of lung cancer, she was an 80-year-old lifelong smoker. This report confirms adalimumab to be an effective agent for ACH.