Li Youli, Wu Yonghe, Cao Sufen, Yu Baohua, Zhang Qunling, Xia Zuguang, Cao Junning, Lv Fangfang, Chen Guang-Liang
Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, P.R. China.
Department of Medical Oncology, Fudan University Shanghai Cancer Center Xiamen Hospital, Xiamen, 361026, P.R. China.
Blood Res. 2024 Oct 30;59(1):36. doi: 10.1007/s44313-024-00042-6.
Immunochemotherapy has demonstrated a promising efficacy for a variety of B-cell lymphoma but has limited efficacy for Epstein-Barr virus-positive (EBV +) diffuse large B-cell lymphoma (DLBCL) that is refractory or relapsed to conventional chemotherapy regimens. Considering higher programmed death-ligand 1 (PD-L1) expression in the subset of patients with DLBCL with positive EBV, we speculated that PD-1 inhibitors plus chemotherapy may be an alternative regimen in patients with refractory/relapsed EBV + DLBCL.
This retrospective study included six adult patients diagnosed with refractory EBV + DLBCL resistant to first-line immunochemotherapy regimens (R-CHOP). These patients received PD-1 inhibitors plus chemotherapy as second-line treatment.
The final analysis included six patients (four men and two women (median age, 50 years; range, 39-83 years)). Four patients were diagnosed with Epstein-Barr virus (EBV) + DLBCL, and two had DLBCL associated with chronic inflammation. Over a median follow-up of 20 months (range, 2-31 months), the objective response rate was 83% (5/6) and the complete remission rate was 67% (4/6). No severe immune-related adverse reactions occurred, and only a mild rash was reported, which did not necessitate the discontinuation of therapy.
The combination of PD-1 inhibitors and chemotherapy offers promising results as a second-line treatment for patients with refractory EBV + DLBCL that is resistant to first-line immunochemotherapy regimens. These preliminary findings warrant further investigation in larger clinical trials to validate the efficacy and safety of this therapeutic approach.
免疫化疗已在多种B细胞淋巴瘤中显示出有前景的疗效，但对于对传统化疗方案难治或复发的爱泼斯坦-巴尔病毒阳性（EBV+）弥漫性大B细胞淋巴瘤（DLBCL）疗效有限。考虑到EBV阳性的DLBCL患者亚组中程序性死亡配体1（PD-L1）表达较高，我们推测PD-1抑制剂联合化疗可能是难治性/复发性EBV+ DLBCL患者的一种替代方案。
这项回顾性研究纳入了6例被诊断为难治性EBV+ DLBCL且对一线免疫化疗方案（R-CHOP）耐药的成年患者。这些患者接受PD-1抑制剂联合化疗作为二线治疗。
最终分析纳入6例患者（4例男性和2例女性，中位年龄50岁，范围39 - 83岁）。4例患者被诊断为爱泼斯坦-巴尔病毒（EBV）+ DLBCL，2例患有与慢性炎症相关的DLBCL。中位随访20个月（范围2 - 31个月），客观缓解率为83%（5/6）。完全缓解率为67%（4/6）。未发生严重的免疫相关不良反应，仅报告了1例轻度皮疹，无需停药。
对于对一线免疫化疗方案耐药的难治性EBV+ DLBCL患者，PD-1抑制剂与化疗联合作为二线治疗可提供有前景的结果。这些初步发现值得在更大规模的临床试验中进一步研究，以验证这种治疗方法的疗效和安全性。
