Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan.
Oncol Res Treat. 2020;43(3):112-116. doi: 10.1159/000504608. Epub 2019 Dec 16.
Plasmablastic lymphoma (PBL) is a rare variant of diffuse large B-cell lymphoma for which no optimal treatment has been established and prognosis remains poor. Here, we describe a human immunodeficiency virus-uninfected patient with PBL that was refractory to conventional chemotherapies but was successfully controlled with a bortezomib-based regimen followed by a lenalidomide-based regimen.
A 64-year-old man suffered from nasal bleeding and occlusion. Whole-body computed tomography results revealed a large lesion occupying his nasal cavity. He was diagnosed with PBL based on a tumor biopsy and was treated with two lines of conventional chemotherapy. A dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) regimen and an ifosfamide, carboplatin, and etoposide (ICE) regimen were ineffective, but the bortezomib-based regimen CyBorD (bortezomib, cyclophosphamide orally, and dexamethasone orally) provided a clinical response. Due to peripheral neuropathy, the patient was then treated with a lenalidomide-based regimen (Ld; lenalidomide and dexamethasone). Although a complete response was not achieved, the Ld regimen was tolerated and was continued with a partial response (PR) for over 2 years.
DISCUSSION/CONCLUSION: In the present case, PBL that was refractory to conventional chemotherapies responded to the CyBorD regimen and a long-term Ld-based regimen without severe adverse effects. This strategy provided and maintained a PR for over 2 years. Despite not resulting in tumor reduction and only maintaining a PR, continued Ld treatment contributed to long-term survival of the present patient with PBL.
浆母细胞淋巴瘤（PBL）是一种罕见的弥漫性大 B 细胞淋巴瘤变异型，目前尚无最佳治疗方法，预后仍然较差。在这里，我们描述了一例人类免疫缺陷病毒阴性的 PBL 患者，该患者对常规化疗无效，但使用硼替佐米为基础的方案和来那度胺为基础的方案后成功得到控制。
一名 64 岁男性因鼻出血和鼻塞就诊。全身计算机断层扫描结果显示鼻腔内有一个大的病变。根据肿瘤活检，他被诊断为 PBL，并接受了两线常规化疗。阿霉素、依托泊苷、长春新碱、环磷酰胺和多柔比星（EPOCH）方案和异环磷酰胺、卡铂和依托泊苷（ICE）方案治疗无效，但硼替佐米为基础的方案 CyBorD（硼替佐米、环磷酰胺口服和地塞米松口服）提供了临床反应。由于周围神经病变，患者随后接受了来那度胺为基础的方案（Ld；来那度胺和地塞米松）治疗。尽管未达到完全缓解，但 Ld 方案耐受良好，并继续维持部分缓解（PR）超过 2 年。
讨论/结论：在本病例中，对常规化疗耐药的 PBL 对 CyBorD 方案和长期 Ld 为基础的方案有反应，且无严重不良反应。这种策略提供并维持了超过 2 年的 PR。尽管没有导致肿瘤缩小，仅维持 PR，但继续使用 Ld 治疗有助于该 PBL 患者的长期生存。
