Deak-Mihaly Dalma, Iluta Sabina, Pasca Sergiu, Jitaru Ciprian, Roman Andrei, Andries Alexandra, Padurariu-Covit Monica, Petrushev Bobe, Vasilache Anca, Bojan Anca, Zdrenghea Mihnea, Dascalescu Angela, Antohe Ion, Colita Anca, Colita Andrei, Dima Delia, Tanase Alina, Tomuleasa Ciprian
Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400005 Cluj Napoca, Romania.
Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
J Clin Med. 2021 Sep 29;10(19):4483. doi: 10.3390/jcm10194483.
Primary central nervous system lymphoma is an uncommon form of extranodal non-Hodgkin's lymphoma, with increasing incidence, a relatively aggressive course and a poor 5-year survival. Because of its localization, the therapeutic compounds used in this disease must be able to pass through the blood-brain barrier. Chemotherapy regimens based on high-dose methotrexate are currently the standard of care for all patients who can tolerate such drugs. Autologous stem cell transplantation is indicated for malignant lymphomas in the relapsed/refractory setting.
Three patients, with a median age of 60 years, range 53-64, were diagnosed with primary CNS lymphoma, and treated with ibrutinib monotherapy in the Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania, between September 2018 and November 2020 All the patients were relapsed-refractory following high-dose methotrexate chemotherapy. We present our experience using ibrutinib monotherapy-based treatment as a bridge-to-transplant option on a single-center case series and a review of the literature in this field.
Two of the patients were given ibrutinib as a second line therapy, both achieving complete remission and being eligible for an autologous stem cell transplantation. The third patient achieved a short remission using six cycles of systemic chemotherapy, but was started on ibrutinib monotherapy, with limited results.
Our data is limited, and these results should be confirmed by multicentric clinical trials and should be regarded as a single-center case series, with all its limitations. Still, it brings forward a new therapeutic option for this rare subtype of malignant lymphomas, which if left untreated has a dismal prognosis.
原发性中枢神经系统淋巴瘤是一种罕见的结外非霍奇金淋巴瘤，发病率呈上升趋势，病程相对侵袭性，5年生存率较低。由于其定位特点，用于该疾病的治疗化合物必须能够穿过血脑屏障。基于大剂量甲氨蝶呤的化疗方案目前是所有能够耐受此类药物的患者的标准治疗方法。自体干细胞移植适用于复发/难治性恶性淋巴瘤。
2018年9月至2020年11月期间，罗马尼亚克卢日-纳波卡市伊翁·奇里库塔临床癌症中心血液科对3例中位年龄为60岁（范围53 - 64岁）的原发性中枢神经系统淋巴瘤患者采用依鲁替尼单药治疗。所有患者在大剂量甲氨蝶呤化疗后均复发难治。我们在单中心病例系列中介绍了使用依鲁替尼单药治疗作为桥接移植选择的经验，并对该领域的文献进行了综述。
2例患者接受依鲁替尼作为二线治疗，均实现完全缓解且符合自体干细胞移植条件。第3例患者通过6个周期的全身化疗实现了短期缓解，但开始接受依鲁替尼单药治疗，效果有限。
我们的数据有限，这些结果应通过多中心临床试验予以证实，且应将其视为具有所有局限性的单中心病例系列。尽管如此，它为这种罕见的恶性淋巴瘤亚型提出了一种新的治疗选择，这种淋巴瘤若不治疗预后很差。
