达雷妥尤单抗联合化疗桥接异基因造血干细胞移植后达雷妥尤单抗联合来那度胺维持治疗原发性浆细胞白血病一例并文献复习

Daratumumab combined with chemotherapy bridging to allogeneic hematopoietic stem cell transplantation followed by daratumumab and lenalidomide maintenance therapy for primary plasma cell leukemia:report of one case and review of literature

目的观察达雷妥尤单抗联合化疗桥接异基因造血干细胞移植(allo-HSCT)后,应用达雷妥尤单抗联合来那度胺维持治疗原发性浆细胞白血病(PCL)的效果及预后。方法回顾性分析云南省第一人民医院2020年1月收治的1例原发性PCL患者临床资料,并复习相关文献。结果该患者诊断为原发性PCL后,采用达雷妥尤单抗联合BD(硼替佐米、地塞米松)方案治疗1个疗程、联合BCDD(硼替佐米、环磷酰胺、脂质体多柔比星、地塞米松)方案治疗2个疗程,达到完全缓解后进行达雷妥尤单抗联合allo-HSCT治疗。供者细胞植入成功,供体细胞嵌合率为94.36%,无急性移植物抗宿主病反应。移植后应用达雷妥尤单抗联合小剂量来那度胺间断维持治疗,至投稿时患者移植后缓解4个月。结论达雷妥尤单抗联合化疗桥接allo-HSCT后应用达雷妥尤单抗联合来那度胺的系列治疗可能会改善原发性PCL的预后,延长生存时间。

Objective To observe the therapeutic efficacy and prognosis of daratumumab combined with chemotherapy bridging to allogeneic hematopoietic stem cell transplantation(allo-HSCT)followed by daratumumab and lenalidomide maintenance treatment for primary plasma cell leukemia(PCL).Methods The clinical data of a patient with primary PCL admitted to the First People's Hospital of Yunnan Province in January 2020 were retrospectively analyzed,and relevant literatures were reviewed.Results The patient was diagnosed with primary PCL and treated with daratumumab combined with BD(bortezomib+dexamethasone)for 1 course and BCDD(bortezomib+cyclophosphamide+liposomaldoxorubicin+dexamethasone)for two courses.The patient was treated with daratumumab combined with allo-HSCT after complete remission.The donor cells were successfully implanted and the chimerism rate of donor cells was 94.36%without acute graft-versus-host disease reaction.And then the patient received intermittent maintenance therapy of daratumumab combined with low dose lenalidomide after transplantation,and the current remission period after transplantation reached 4 months.Conclusions Daratumumab combined with chemotherapy bridging to allo-HSCT followed by daratumumab and lenalidomide may improve the prognosis of primary PCL and prolong survival time.