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[自体外周血干细胞移植后长期缓解的HIV阴性浆母细胞淋巴瘤]

[HIV-negative plasmablastic lymphoma sustaining long-term response after autologous peripheral blood stem cell transplantation].

作者信息

Kitagawa Tomoya, Onaka Takashi, Yonezawa Akihito

机构信息

Department of Hematology, Kokura Memorial Hospital.

Department of Hematology, Kansai Electric Power Hospital.

出版信息

Rinsho Ketsueki. 2022;63(3):201-205. doi: 10.11406/rinketsu.63.201.

Abstract

The patient is a 34-year-old HIV antibody-negative female with normal immunocompetence. The patient was referred to the hospital of the current study due to diarrhea and abdominal pain, which developed in May 2014. On conducting computed tomography (CT), remarkable wall thickening was noted in the terminal ilium over the ascending colon, suggesting a malignant tumor. However, making a definite diagnosis by lower gastrointestinal endoscopic biopsy and left hemicolectomy was not possible. The dense proliferation of plasma cell-like cells and plasmablasts was noted; CD20, CD19, CD79a, CD3, CD4, and Epstein-Barr virus-encoded miRNAs (EBER) were negative and CD138 was positive on immunostaining. Based on the aforementioned data, the patient was diagnosed with plasmablastic lymphoma (PBL). High-dose chemotherapy combined with autologous peripheral blood stem cell transplantation (PBSCT) was performed in the first remission period after the completion of four cycles of hyper CVAD/MTX-AraC alternating therapy. Remission was confirmed by FDG-PET/CT 3 months after autologous PBSCT. No signs of recurrence have been observed in 6 years after the transplantation. Although no standard treatment for PBL has been established, autologous peripheral blood stem cell transplantation combined with high-dose chemotherapy during the first remission period may be a beneficial treatment option.

摘要

该患者为一名34岁的HIV抗体阴性女性,免疫功能正常。患者因腹泻和腹痛于2014年5月转诊至本研究所在医院。进行计算机断层扫描(CT)时,发现升结肠末端回肠壁显著增厚,提示为恶性肿瘤。然而,通过下消化道内镜活检和左半结肠切除术无法做出明确诊断。观察到浆细胞样细胞和成浆细胞密集增殖;免疫染色显示CD20、CD19、CD79a、CD3、CD4和爱泼斯坦-巴尔病毒编码的微小RNA(EBER)均为阴性,而CD138为阳性。根据上述数据,该患者被诊断为浆母细胞性淋巴瘤(PBL)。在完成四个周期的hyper CVAD/MTX-AraC交替治疗后的首次缓解期,进行了大剂量化疗联合自体外周血干细胞移植(PBSCT)。自体PBSCT后3个月,通过FDG-PET/CT确认缓解。移植后6年未观察到复发迹象。尽管尚未确立PBL的标准治疗方法,但在首次缓解期进行自体外周血干细胞移植联合大剂量化疗可能是一种有益的治疗选择。

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