Department of Infectious Diseases II, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.
Department of hematology, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.
AIDS Res Ther. 2023 Aug 29;20(1):63. doi: 10.1186/s12981-023-00554-8.
Despite increasing effort for treating primary central nervous system lymphoma (PCNSL), the prognosis of human immunodeficiency virus (HIV) -related PCNSL was still unsatisfactory. There is currently a lack of clinical evidence for the application of Bruton tyrosine kinase (BTK) inhibitor in HIV-related PCNSL. We reported two HIV-related PCNSL patients, who achieved sustained remission by application of BTK inhibitor based treatment. This protocol had not been previously reported for the treatment of HIV-related PCNSL.
The two cases were characterized by the treatment choice of Bruton tyrosine kinase (BTK) inhibitor. Rituximab was not recommended for them due to their very low CD4 T cell counts. They both took MTX as the first-line therapy and got a relief in initial phase. For the first case, ibrutinib was kept both in the first-line therapy and in the maintenance therapy. When the second case underwent a progressive disease, we continued to use orelabrutinib as one of the salvage treatment, in combination with programmed cell death-1 (PD-1) inhibitor plus lenalidomide. They both achieved a continuous response of up to 20 months without opportunistic infection.
This report highlights the safety and effectiveness of BTK inhibitors, as well as lenalidomide and PD-1 inhibitor in HIV-related PCNSL patients. Both the new therapeutic approaches and a multidisciplinary team authentically contributed to improved survival outcome among HIV-positive PCNSL patients.
尽管针对原发性中枢神经系统淋巴瘤（PCNSL）的治疗已投入大量精力，但人类免疫缺陷病毒（HIV）相关 PCNSL 的预后仍不尽如人意。目前，尚无 BTK 抑制剂在 HIV 相关 PCNSL 中应用的临床证据。我们报告了两例 HIV 相关 PCNSL 患者，他们通过应用 BTK 抑制剂治疗实现了持续缓解。该方案以前未用于治疗 HIV 相关 PCNSL。
这两例病例的治疗选择均为 Bruton 酪氨酸激酶（BTK）抑制剂。由于他们的 CD4 T 细胞计数非常低，不建议使用利妥昔单抗。他们都接受 MTX 作为一线治疗，并在初始阶段得到缓解。对于第一个病例，伊布替尼一直用于一线治疗和维持治疗。当第二个病例出现疾病进展时，我们继续使用奥雷巴替尼作为一种挽救性治疗，联合程序性细胞死亡-1（PD-1）抑制剂加来那度胺。他们都连续缓解了 20 个月，没有机会性感染。
本报告强调了 BTK 抑制剂以及来那度胺和 PD-1 抑制剂在 HIV 相关 PCNSL 患者中的安全性和有效性。新的治疗方法和多学科团队都为改善 HIV 阳性 PCNSL 患者的生存结果做出了贡献。
