双表达弥漫大B细胞淋巴瘤自体造血干细胞移植复发后嵌合抗原受体T细胞免疫治疗持续缓解一例并文献复习

Chimeric antigen receptor T cell immunotherapy for sustained remission of double expression diffuse large B-cell lymphoma after the recurrence of autologous hematopoietic stem cell transplantation:report of one case and review of literature

目的探讨双表达淋巴瘤患者自体造血干细胞移植复发后嵌合抗原受体T细胞(CAR-T)的治疗效果。方法回顾性分析1例于2017年8月就诊于河南省人民医院且在自体造血干细胞移植复发后接受CAR-T治疗的双表达弥漫大B细胞淋巴瘤患者的治疗过程,并复习相关文献。结果该例50岁女性双表达弥漫大B细胞淋巴瘤患者,经标准方案化疗后以BEAM为预处理方案行自体造血干细胞移植,移植后5个月复发,后经含克拉屈滨的化疗方案治疗2个疗程,桥接CAR-T治疗,获得持续缓解,且持续8个月患者体内能检测到CD20+-CAR-T。结论对于自体造血干细胞移植后复发的非霍奇金淋巴瘤患者,先采用含克拉屈滨的方案诱导缓解后行序贯CAR-T治疗可能是一个较好的选择。

Objective To investigate the therapeutic efficacy of chimeric antigen receptor T cell(CAR-T)for treatment of relapsed patients with double expression lymphoma after autologous hematopoietic stem cell transplantation(auto-HSCT).Methods The treatment process of one patient with double expression diffuse large B-cell lymphoma who received CAR-T immunotherapy after the recurrence of auto-HSCT in Henan Provincial People's Hospital in August,2017 was retrospectively analyzed,and the related literature was reviewed.Results A 50-year-old female double expression diffuse large B-cell lymphoma patient received the standard treatment regimen,and then had auto-HSCT based on the BEAM preconditioning regimen.The patient relapsed after 5 months,and finally got sustained remission after chemotherapy regimen containing cladribine for 2 courses of treatment combined with CAR-T therapy.CD20+-CAR-T cells were detected in this patient for 8 mouths sustainably.Conclusion For relapsed patients with non-Hodgkin lymphoma after auto-HSCT,reduction remission of the treatment regimen containing cladribine followed by CAR-T sequential regimen may be a better treatment option.