Kikuchi Shohei, Nabe Yoshimi, Horaguchi Ryusuke, Minemura Tomoki, Murakami Jun, Noguchi Akira, Takagi Kohji, Kamihara Yusuke, Wada Akinori, Fujihira Takuma, Sato Tsutomu
Department of Hematology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152 Japan.
Division of Transfusion Medicine and Cell Therapy, Toyama University Hospital, Toyama, Japan.
Int Cancer Conf J. 2024 Aug 21;13(4):488-492. doi: 10.1007/s13691-024-00716-z. eCollection 2024 Oct.
Though multiple relapses and serial shortening of remission is one of the characteristics of follicular lymphoma (FL), standard third- and later-line treatments with clear evidence have not yet been established. Tazemetostat, the first oral enhancer of zester homolog 2 ( inhibitor, showed a favorable clinical outcome and safety profile against relapsed mutant FL in a clinical trial and was applied to this clinical setting. Peripheral blood involvement, known as the leukemic phase, was observed in approximately 10% of patients with FL and reported as a poor prognostic factor. However, because of the infrequency of -activating mutations, clinical data on tazemetostat against FL in the leukemic phase is lacking. Herein, we report a case of multiple relapsed FL in the leukemic phase for which tazemetostat was administered as a sixth-line treatment. Tazemetostat monotherapy showed a slow and sustained clinical efficacy in the leukemic phase as shown by nodal involvement. Circulating lymphoma cells gradually decreased and disappeared in counts after 4 months of treatment. However, circulating lymphoma cells were still detected by flow cytometry up to 6 months of treatment and finally undetected after 9 months. Extended-interval dosing of tazemetostat transformed a partial response into a complete response. Thus, tazemetostat is effective for the treatment of multiple relapsed FL in the leukemic phase.
尽管多次复发和缓解期持续缩短是滤泡性淋巴瘤（FL）的特征之一，但尚无明确证据支持的标准三线及后续治疗方案。他泽司他是首个口服的锌指同源物2（EZH2）抑制剂，在一项临床试验中显示出针对复发突变型FL的良好临床疗效和安全性，并被应用于该临床场景。外周血受累，即白血病期，在约10%的FL患者中观察到，并被报道为不良预后因素。然而，由于EZH2激活突变的发生率较低，缺乏他泽司他针对白血病期FL的临床数据。在此，我们报告一例白血病期多次复发的FL病例，他泽司他作为六线治疗药物。他泽司他单药治疗在白血病期显示出缓慢而持续的临床疗效，如淋巴结受累情况所示。治疗4个月后，循环淋巴瘤细胞计数逐渐减少并消失。然而，直至治疗6个月时，流式细胞术仍能检测到循环淋巴瘤细胞，最终在9个月后未检测到。他泽司他延长给药间隔将部分缓解转化为完全缓解。因此，他泽司他对白血病期多次复发的FL治疗有效。
