1例难治性原发中枢弥漫大B细胞淋巴瘤CAR-T细胞治疗中的多学科联合诊治

Multidisciplinary treatment combination in CAR-T therapy for refractory primary central nerves system diffuse large B-cell lymphoma

本文介绍1例原发中枢弥漫大B细胞淋巴瘤合并重症感染并气管插管患者的多学科联合诊治(MDT)过程。该患者初期起病隐匿,诊断困难,辗转于神经内科、神经外科、血液科就诊,经过多次腰椎穿刺检查后最终确诊原发中枢神经系统弥漫大B细胞淋巴瘤,给予多次化疗后未能获得完全缓解,且合并重症感染并行气管插管治疗,患者再次转至我院血液科治疗。经过我院MDT讨论,为患者制定了一个全面详尽的治疗方案,包括桥接化疗、CAR-T细胞治疗,在此过程中淋巴瘤获得完全缓解,患者一般状况明显好转。该患者的诊治过程体现了MDT在难治性原发中枢神经系统弥漫大B细胞淋巴瘤患者中,尤其是合并复杂并发症的患者中存在重要的价值,对于明确患者诊断、提供最佳治疗方案、改变预后结局,发挥着决定性的作用。

This work describes the multidisciplinary diagnosis and treatment(MDT) of a patient with primary central nerves system diffuse large B-cell lymphoma complicated with severe infection and endotracheal intubation. The patient had insidious onset. She received treatment in the department of neurology and neurosurgery, and finally got successfully treated in our department of hematology. The diagnosis was difficult made, by lumbar puncture examination repeatedly. She was finally diagnosed with the primary central nerves system diffuse large B-cell lymphoma, but failed to get complete remission after several cycles of immunochemotherapy. She was also complicated with severe infection and endotracheal intubation, and she was transferred to our hospital again. After MDT discussion in our hospital, we gave this patient an elaborate treatment plan, including chemotherapy bridge CAR-T cell therapy. In this process, the patient achieved complete remission, and the patient’s general condition was significantly improved. This case’s diagnosis and treatment process demonstrates that MDT still has important value in patients with refractory primary central nerves system diffuse large B-cell lymphoma, especially those with complex complications. MDT plays a decisive role in clarifying the diagnosis, providing the best treatment plan, and changing the prognosis outcome.