Department of Haematology and Oncology, University Hospital Halle (Saale), Halle (Saale), Germany.
Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Eur J Haematol. 2018 Jul;101(1):115-118. doi: 10.1111/ejh.13072. Epub 2018 May 11.
Recurrence of primary central nervous system lymphoma (PCNSL) after high-dose chemotherapy with autologous stem cell transplantation (ASCT) usually has a poor overall prognosis with limited treatment options. Data on repeated ASCT are sparse. Checkpoint inhibitor maintenance therapy has also not been reported in PCNSL. Here, we report the first documented case of a successful third ASCT in second relapse of PCNSL. Whole-exome sequencing identified a hypermutated tumor genotype. Additionally, immunohistochemistry on pretreatment tumor tissue revealed infiltrates of PD-1 cytolytic T cells. These alterations provided a rationale for subsequent nivolumab maintenance treatment. Therapy led to a long-term, ongoing complete remission. In eligible patients with recurrent MTX-sensitive PCNSL, multiple long-term remissions can be induced by repetition of high-dose MTX-based chemotherapy followed by autologous retransplantation. Subsequent immune checkpoint inhibitor maintenance therapy might be able to prolong or maintain remission.
原发性中枢神经系统淋巴瘤（PCNSL）在接受大剂量化疗联合自体造血干细胞移植（ASCT）后复发，通常整体预后较差，治疗选择有限。关于重复 ASCT 的数据很少。此外，也没有关于检查点抑制剂维持治疗在 PCNSL 中的报告。在这里，我们报告了首例成功的第三例 ASCT 用于治疗 PCNSL 第二次复发的病例。全外显子组测序确定了一种高突变肿瘤基因型。此外，预处理肿瘤组织的免疫组化显示 PD-1 细胞毒性 T 细胞浸润。这些改变为随后的纳武单抗维持治疗提供了依据。治疗导致了长期持续的完全缓解。对于复发的 MTX 敏感 PCNSL 患者，如果重复使用大剂量 MTX 为基础的化疗联合自体再移植，可诱导多次长期缓解。随后的免疫检查点抑制剂维持治疗可能能够延长或维持缓解。
