Hematology and Oncology, The University of Texas McGovern Medical School, Houston, Texas, USA.
Department of Internal Medicine, Division of Hematology and Oncology, University of Texas McGovern Medical School, Houston, Texas, USA
BMJ Case Rep. 2022 Jun 22;15(6):e249631. doi: 10.1136/bcr-2022-249631.
Mantle cell lymphoma (MCL) is an incurable B cell non-Hodgkin's lymphoma with a variable clinical course. Central nervous system (CNS) involvement is a rare and dreaded complication in MCL. We report a case of leptomeningeal relapse of MCL that was successfully treated with a single-agent Bruton's tyrosine kinase inhibitor. A man in his 50s with MCL was treated with six cycles of bendamustine-rituximab, achieving a complete remission (CR) and was subsequently placed on rituximab maintenance for 2 years. Four years later, he was hospitalised with symptoms of organic brain syndrome. Brain MRI and cerebrospinal fluid analysis confirmed CNS relapse of MCL. He was treated with dexamethasone, ibrutinib 560 mg/day and intrathecal cytarabine with improvement in neurological symptoms, and a follow-up MRI showed CR. The patient was later switched to acalabrutinib due to intolerance to ibrutinib. The patient is tolerating this regimen well, remaining in CR 3 years later.
套细胞淋巴瘤（Mantle cell lymphoma，MCL）是一种不可治愈的 B 细胞非霍奇金淋巴瘤，其临床病程具有多变性。中枢神经系统（Central nervous system，CNS）受累是 MCL 一种罕见且令人担忧的并发症。我们报告了一例套细胞淋巴瘤脑膜复发的病例，该病例成功地接受了单一 Bruton 酪氨酸激酶抑制剂治疗。一名 50 多岁的男性患有 MCL，他接受了六个周期的苯达莫司汀-利妥昔单抗治疗，达到完全缓解（Complete remission，CR），随后接受利妥昔单抗维持治疗 2 年。4 年后，他因有机脑综合征的症状住院。脑 MRI 和脑脊液分析证实了 MCL 的中枢神经系统复发。他接受了地塞米松、560mg/天的伊布替尼和鞘内阿糖胞苷治疗，神经症状得到改善，随访 MRI 显示 CR。由于不耐受伊布替尼，该患者后来换用阿卡替尼。该患者对该方案耐受良好，3 年后仍处于 CR 状态。
