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Abstract：
Nasopharyngeal carcinoma with bone marrow metastasis presents a rare and challenging clinical scenario associated with exceedingly poor prognosis. While standard treatment regimens offer limited efficacy and tolerability in such cases, individualized approaches are increasingly necessary. We present the case of a 64-year-old male diagnosed with recurrent nonkeratinizing undifferentiated nasopharyngeal carcinoma with extensive bone marrow metastasis (rTxN0M1). Treatment was initiated with immunotherapy-based combination therapy, consisting of pembrolizumab and low-dose cisplatin, which resulted in an initial response. Subsequently, there was a transition to standard-dose nab-paclitaxel-cisplatin chemotherapy in combination with pembrolizumab, followed by maintenance therapy with pembrolizumab plus fruquintinib. The patient achieved a sustained response with renormalization of tumor markers, imaging findings, and bone biopsies, resulting in complete remission. This case highlights the successful management of nasopharyngeal carcinoma with extensive bone marrow metastasis through an individualized treatment approach incorporating immunotherapy.
摘要：
伴有骨髓转移的鼻咽癌呈现出罕见且具有挑战性的临床情景，与预后极差相关。虽然在这种情况下，标准治疗方案的疗效和耐受性有限，个性化的方法越来越必要。我们介绍了一名64岁男性，被诊断为复发性非角质化未分化鼻咽癌并伴有广泛的骨髓转移（rTxN0M1）。治疗开始于基于免疫疗法的联合治疗，由pembrolizumab和低剂量顺铂组成，这导致了最初的反应。随后，有一个过渡到标准剂量nab-紫杉醇-顺铂化疗联合pembrolizumab，其次是pembrolizumab+fruquintinib维持治疗.患者通过肿瘤标志物的重新规范化实现了持续的反应，影像学发现，骨活检，导致完全缓解。该病例强调了通过结合免疫疗法的个体化治疗方法成功治疗鼻咽癌广泛的骨髓转移。
