This negative result could be due to DDX3X mutation since it was previously shown that DDX3X mutation was associated with poor prognosis.28,46 Further, a recent study showed that DDX3X mutation could affect cell-fate decisions in cells under stress conditions by regulating NLRP3 inflammasome.47 In our study, the DDX3X mutation might change the response of NKTL to the stress induced by anti-PD-1 antibody and P-GEMOX, leading to the blocking of lymphoma cell death and drug resistance. This evidence concerns the gene DDX3X and lymphoma.