Wang Ge, Zhou Xiaoxi, Wang Pengcheng, Mao Zekai
Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Immunol. 2025 Aug 28;16:1581654. doi: 10.3389/fimmu.2025.1581654. eCollection 2025.
Primary cardiac lymphoma (PCL), an exceedingly rare and aggressive extranodal lymphoma confined to the heart and/or pericardium, poses significant diagnostic and therapeutic challenges with a historically dismal prognosis. We present the first documented case of PCL achieving sustained complete response (CR) through a novel therapeutic approach combining autologous hematopoietic stem cell transplantation (ASCT) with sequential tandem CD19/20 CAR-T therapy. A 55-year-old female presented with chest tightness and pericardial effusion in April 2023. The diagnostic process involved multiple modalities and analyses, culminating in a diagnosis via CT-guided mediastinal lymph node biopsy. The patient underwent several chemotherapy regimens, including combinations of rituximab and polatuzumab vedotin, R-CHOP, Pola-R-CHP, and Pola-R-DA-EPOCH, which led to symptom relief and partial response. Subsequently, ASCT was performed, followed by sequential tandem CD19/20 CAR-T therapy. As a maintenance treatment, the PD-1 inhibitor sintilimab was administered approximately every two months. The patient achieved CR at month 3 and maintained CR for one year following the CAR-T infusion. Following CAR-T therapy, the patient developed immune effector cell-associated hematologic toxicity, which was managed with granulocyte colony-stimulating factor injection and supportive care. This case illustrates the difficulties in diagnosing and treating PCL. Through the combination of ASCT and sequential tandem CD19/20 CAR-T therapy, the patient achieved sustained CR with manageable toxicity. This case demonstrates the feasibility, safety, and potential efficacy of this combination strategy in treating high-risk lymphoma. Moreover, we propose a structured algorithm that may help optimize the clinical implementation of CAR-T therapy in similar cases. Continued follow-up and broader studies are warranted to validate these findings.
原发性心脏淋巴瘤（PCL）是一种极为罕见且侵袭性强的结外淋巴瘤，局限于心脏和/或心包，在诊断和治疗方面面临重大挑战，历史预后不佳。我们报告了首例通过将自体造血干细胞移植（ASCT）与序贯串联CD19/20嵌合抗原受体T细胞（CAR-T）疗法相结合的新型治疗方法实现持续完全缓解（CR）的PCL病例。一名55岁女性于2023年4月出现胸闷和心包积液。诊断过程涉及多种检查方法和分析，最终通过CT引导下纵隔淋巴结活检确诊。患者接受了多种化疗方案，包括利妥昔单抗和泊洛妥珠单抗、R-CHOP、Pola-R-CHP以及Pola-R-DA-EPOCH的联合使用，这些方案使症状得到缓解并取得部分缓解。随后进行了ASCT，接着是序贯串联CD19/20 CAR-T治疗。作为维持治疗，大约每两个月给予一次程序性死亡受体1（PD-1）抑制剂信迪利单抗。患者在第3个月时达到CR，并在CAR-T输注后维持CR一年。CAR-T治疗后，患者出现免疫效应细胞相关的血液学毒性，通过注射粒细胞集落刺激因子和支持治疗进行处理。该病例说明了PCL诊断和治疗的困难。通过ASCT与序贯串联CD19/20 CAR-T治疗相结合，患者实现了持续CR且毒性可控。该病例证明了这种联合策略在治疗高危淋巴瘤方面的可行性、安全性和潜在疗效。此外，我们提出了一种结构化算法，可能有助于优化类似病例中CAR-T治疗的临床应用。需要持续随访和更广泛的研究来验证这些发现。
