Department of Hematology, Shaoxing Second Hospital, Shaoxing, China.
Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Front Immunol. 2022 Jun 10;13:894787. doi: 10.3389/fimmu.2022.894787. eCollection 2022.
Failure to CD19-targeted chimeric antigen receptor T-cell (CAR-T) therapy for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL), is an emerging clinical problem. There is no consensus on the treatment for these patients and treatment remains empirical.
We reported a case of an elderly R/R DLBCL patient who had mutation and relapsed 12 months after initial response to CAR T-cell therapy. The patient did not respond to salvage chemotherapy with the GDP regimen and could not tolerate any aggressive chemotherapy. Thereafter, the patient was given chidamide and zanubrutinib. After two months of treatment, the patient achieved sustained complete remission. At the last follow-up, the patient remains in radiographic CR 22 months after CAR-T infusion and 10 months after the initiation of the combination treatment.
We report the first successful case of dual inhibition of HDAC and BTK for the treatment of R/R DLBCL after failure to CAR-T cell therapy, which opens a new therapeutic possibility for the future.
对于复发/难治性（R/R）弥漫性大 B 细胞淋巴瘤（DLBCL）患者，未能进行 CD19 靶向嵌合抗原受体 T 细胞（CAR-T）治疗是一个新出现的临床问题。对于这些患者的治疗尚无共识，治疗仍然是经验性的。
我们报告了一例老年 R/R DLBCL 患者，该患者存在基因突变，在对 CAR-T 细胞治疗有初始反应 12 个月后复发。该患者对 GDP 方案的挽救性化疗无反应，且不能耐受任何强化化疗。此后，患者接受了西达本胺和泽布替尼治疗。治疗两个月后，患者达到持续完全缓解。末次随访时，CAR-T 输注后 22 个月和联合治疗后 10 个月，患者仍处于影像学完全缓解。
我们报告了首例在 CAR-T 细胞治疗失败后，采用 HDAC 和 BTK 双重抑制治疗 R/R DLBCL 的成功案例，为未来开辟了新的治疗可能性。
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