Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy,
Chemotherapy. 2020;65(5-6):161-165. doi: 10.1159/000512541. Epub 2021 Jan 21.
Eleven years ago, a 64-year-old Caucasian man had LNH Follicular 3a, IV A stage, FLIPI 2 as a prognostic index of follicular lymphoma. He received 8 cycles of RCHOP followed by rituximab maintenance, with complete remission. Due to a systemic recurrence, a new treatment schedule (RCOMP, 6 cycles) was introduced with partial remission persisting during a long-term maintenance treatment with rituximab. Three years ago, LNH Follicular 3a progressed into GC type diffuse large B-cell lymphomas (DLBCL); 6 cycles of rituximab and bendamustine were followed by R-ICE and R OXALI DHAP treatments without beneficial effect. Due to the worse general condition (ECOG 3-4), the patient was treated with pixantrone (6 cycles) until July 10, 2019, with a partial response. On Jan 13, 2020, an extreme compassioned treatment with venetoclax alone was started; this drug was well tolerated and provided a satisfactory clinical and laboratory improvement. In June 2020, however, he developed bone marrow toxicity and septic fever. Nasal and pharyngeal secretions were SARS-CoV-2 RNA negative. Blood cultures for mycotic agents and Gram-positive, Gram-negative, and anaerobic bacteria were negative, but few days later, the patients died of sepsis due to unidentified agents. The use of venetoclax as a single drug to treat DLBCL BCL2 patients deserves further investigation.
十一年前，一位 64 岁的白种人男性患有滤泡性淋巴瘤 3a 期，IV A 期，FLIPI 2 作为滤泡性淋巴瘤的预后指数。他接受了 8 个周期的 RCHOP 联合利妥昔单抗维持治疗，达到完全缓解。由于全身复发，引入了新的治疗方案（RCOMP，6 个周期），在长期利妥昔单抗维持治疗期间保持部分缓解。三年前，滤泡性淋巴瘤 3a 进展为 GC 型弥漫性大 B 细胞淋巴瘤（DLBCL）；接受 6 个周期的利妥昔单抗和苯达莫司汀治疗后，又接受了 R-ICE 和 R-OXALI-DHAP 治疗，但无获益。由于一般状况较差（ECOG 3-4），患者接受了 pixantrone（6 个周期）治疗，直至 2019 年 7 月 10 日，部分缓解。2020 年 1 月 13 日，开始单独用 venetoclax 进行极端同情治疗；该药耐受性良好，提供了令人满意的临床和实验室改善。然而，2020 年 6 月，患者出现骨髓毒性和脓毒症发热。鼻和咽分泌物 SARS-CoV-2 RNA 为阴性。真菌、革兰阳性菌、革兰阴性菌和厌氧菌的血培养均为阴性，但几天后，患者因不明原因的病原体导致败血症死亡。单独使用 venetoclax 治疗 BCL2 阳性的 DLBCL 患者值得进一步研究。
