Medical School of Ningbo University.
Ningbo First Hospital, Zhejiang, People's Republic of China.
Medicine (Baltimore). 2021 Feb 19;100(7):e24498. doi: 10.1097/MD.0000000000024498.
No standard guideline has been established for the treatment of plasmablastic lymphoma (PBL) and prognosis remains extremely poor, given that patients relapse early after chemotherapy and show resistance to commonly used cytostatic drugs.
We present the case of a 52-year-old HIV-negative man who presented with a mass at the left sternoclavicular joint. He had no significant comorbidities and no latent immunosuppression.
The largest lymph node measured was 36 × 19 mm. An excisional biopsy showed diffuse proliferation of large lymphoid cells which were positive for CD38 and CD138, but negative for CD20. He was diagnosed with stage IV PBL with a low IPI.
The patient was treated with four cycles of induction therapy with bortezomib, epirubicin and dexamethasone. He achieved complete remission. But 3 months after receiving consolidated autologous hematopoietic stem cell transplantation, he relapsed. Allogeneic hematopoietic stem cell transplantation was performed on the patient.
The patient achieved remission again and there were no serious complications after allogeneic hematopoietic stem cell transplantation. This patient was followed up once every three months, and to date, he has been disease-free for more than 4 years.
The survival of recurrent PBL after autologous hematopoietic stem cell transplantation is very poor. Salvage allogeneic hematopoietic stem cell transplantation may bring long-term survival opportunities for those patients. Further clinical studies are needed to explore the role of allogeneic hematopoietic stem cell transplantation in refractory and recurrent PBL.
由于化疗后患者早期复发且对常用细胞毒药物产生耐药性,因此尚无治疗浆母细胞淋巴瘤(PBL)的标准指南,预后极差。
我们报告了 1 例 52 岁 HIV 阴性男性,左胸锁关节处有肿块。他没有明显的合并症,也没有潜伏性免疫抑制。
最大的淋巴结测量为 36×19mm。切除活检显示大淋巴细胞弥漫性增殖,CD38 和 CD138 阳性,但 CD20 阴性。他被诊断为 IV 期 PBL,IPI 低。
患者接受了 4 个周期的硼替佐米、表柔比星和地塞米松诱导治疗。他达到了完全缓解。但在接受巩固性自体造血干细胞移植后 3 个月,他复发了。对患者进行了异基因造血干细胞移植。
患者再次缓解,异基因造血干细胞移植后无严重并发症。该患者每 3 个月随访一次,至今无病生存超过 4 年。
自体造血干细胞移植后复发的 PBL 患者的生存情况非常差。挽救性异基因造血干细胞移植可能为那些患者带来长期生存机会。需要进一步的临床研究来探讨异基因造血干细胞移植在难治性和复发性 PBL 中的作用。