■滤泡性淋巴瘤(FL),常见的惰性B细胞淋巴瘤,有可能转变为侵袭性淋巴瘤,如弥漫性大B细胞淋巴瘤(DLBCL)。转化滤泡性淋巴瘤(tFL)患者的预后较差,尤其是化疗后转化淋巴瘤患者和24个月内进展的患者(POD24)。嵌合抗原受体(CAR)T细胞疗法联合自体干细胞移植(ASCT)具有良好的抗肿瘤疗效。
■这里,我们描述了一名39岁的男性患者,最初被诊断为FL,转化为具有POD24,CD20阴性的DLBCL,TP53突变,经过3行治疗后,肿块很大,所有这些都是不良预后因素.我们应用了一种组合方法:ASCT后的CD19CART细胞输注。伊布替尼持续服用以提高疗效,DHAP作为挽救性化疗,ICE作为桥接方案施用。患者在-7~-1天接受BEAM预处理,在第01~02天总共输注3.8×106/kgCD34+干细胞,总共108个CART细胞(relmacabtageneautoleucel,relma-cel,JWCAR029)在第03天输注。患者出现2级细胞因子释放综合征(CRS),根据机构标准表现为发热和低血压。CAR-T细胞输注后无免疫效应细胞相关神经毒性综合征(ICANS)。最后,患者在+1个月时达到CMR,一直保持没有任何其他不利影响。
■这个案例突出了CD19CART细胞疗法在ASCT后对R/RtFL的惊人功效,从而为未来的治疗策略提供新的见解。
Follicular lymphoma (FL), a common indolent B-cell lymphoma, has the potential to transform into an aggressive lymphoma, such as diffuse large B-cell lymphoma (DLBCL). The outcome of patients with transformed follicular lymphoma (tFL) is poor, especially in patients with transformed lymphoma after chemotherapy and patients with progression within 24 months (POD24). Chimeric antigen receptor (CAR) T-cell therapy combined with autologous stem cell transplantation (ASCT) has promising antitumor efficacy.
Here, we described a 39-year-old male patient who was initially diagnosed with FL that transformed into DLBCL with POD24, CD20 negativity, TP53 mutation, and a bulky mass after 3 lines of therapy, all of which were adverse prognostic factors. We applied a combination approach: CD19 CAR T-cell infusion following ASCT. Ibrutinib was administered continuously to enhance efficacy, DHAP was administered as a salvage chemotherapy, and ICE was administered as a bridging regimen. The patient underwent BEAM conditioning on days -7~ -1, a total of 3.8 × 106/kg CD34+ stem cells were infused on days 01~02, and a total of 108 CAR T cells (relmacabtagene autoleucel, relma-cel, JWCAR029) were infused on day 03. The patient experienced grade 2 cytokine release syndrome (CRS), manifesting as fever and hypotension according to institutional standards. There was no immune effector cell-associated neurotoxicity syndrome (ICANS) after CAR T-cell infusion. Finally, the patient achieved CMR at +1 month, which has been maintained without any other adverse effects.
This
case highlights the amazing efficacy of CD19 CAR T-cell therapy following ASCT for R/R tFL, thus providing new insight on therapeutic strategies for the future.