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Multiply Relapsed Secondary CNS Non-Germinal Center Diffuse Large B-Cell Lymphoma Successfully Treated with
Lyndsey L Fournier1, ErinMarie O Kimbrough1, Muhamad Alhaj Moustafa1
1Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA.
This case study details a patient with multiply relapsed diffuse large B-cell lymphoma (DLBCL) in the central nervous system (CNS). A CNS-centric approach with novel agents and a second stem cell transplant led to a rare, sustained remission.
Area of Science:
- Oncology
- Hematology
- Neurology
Background:
- Secondary central nervous system (CNS) involvement in diffuse large B-cell lymphoma (DLBCL) portends a poor prognosis.
- Intracerebral CNS-only relapse of non-germinal center DLBCL (NGC-DLBCL) is challenging to manage.
- Standard treatments often fail to prevent or adequately treat CNS recurrence.
Observation:
- A patient with NGC-DLBCL experienced two isolated intracerebral relapses.
- Initial treatment included R-CHOP, intrathecal methotrexate, and autologous stem cell transplant (ASCT).
- Subsequent relapses were treated with whole brain radiation therapy (WBRT) and then a CNS-centric salvage regimen.
Findings:
- The second relapse was treated with chemoimmunotherapy (rituximab, high-dose methotrexate, high-dose cytarabine, ibrutinib) and a second ASCT with carmustine and thiotepa.
- Maintenance ibrutinib was initiated due to high risk of recurrence.
- The patient achieved a 3-year complete remission, which is rare in multiply relapsed secondary CNS lymphoma (SCNSL).
Implications:
- A CNS-centric therapeutic strategy may salvage patients with multiply relapsed SCNSL.
- Novel agents like ibrutinib show promise in managing refractory CNS lymphoma.
- Further research is needed to validate this approach for SCNSL.
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