Toripalimab plus lenalidomide for central nervous system recurrence in refractory CD5⁺ diffuse large B-cell lymphoma...

CD5-positive (CD5⁺) non-germinal center B-cell-like diffuse large B-cell lymphoma (non-GCB DLBCL) is heterogeneous with a poor prognosis. For refractory DLBCL, the median overall survival was only 6.3 months. Therefore, there is a need for approaches to elongate the survival in this subgroup of relapsed DLBCL patients.

Here, we present a rare case of a 72-year-old patient with stage IV CD5⁺ non-GCB DLBCL with myeloid differentiation primary response 88 (MYD88) and cluster of differentiation 79B (CD79B) comutations. Zanubrutinib and rituximab therapy was initially administered until disease progression. Subsequently, zanubrutinib plus rituximab together with attenuated standard chemotherapy (miniCHOP) was applied and a notable response was observed. The patient tolerated the treatment well and exhibited a complete response in lung for about 5 months. Afterwards, the patients experienced relapse in the brain and started programmed death protein 1 (PD-1) regimens of toripalimab plus lenalidomide, which also exhibited a good response with decreased lesions in brain after half-year treatment. However, the patient experienced relapse again in the brain 3 months later and started chemotherapy with methotrexate plus rituximab. The patient had survived for over 2 years since the initial diagnosis of stage IV DLBCL and has continued to survive after experiencing a relapse in the brain for approximately 11 months till now.

These findings suggest that toripalimab may be a new therapeutic option for central nervous system recurrence in refractory CD5⁺ DLBCL with MYD88 and CD79B comutation. Further clinical trials are warranted to confirm these results.