高级别B细胞淋巴瘤伴C-myc/BCL2/BCL6重排患者三线格菲妥单抗单药挽救治疗1例

Third-line glofitamab monotherapy as salvage treatment for a patient with HGBL harboring C-myc/BCL2/BCL6 rearrangements: A case report

摘要:

目的 探讨格菲妥单抗用于高级别B细胞淋巴瘤（HGBL）后线挽救治疗的疗效和安全性。方法 采用病例报告结合文献分析的方法，对1例55岁女性HGBL伴C-myc/BCL2/BCL6基因重排患者接受格菲妥单抗（CD20和CD3双特异性抗体）三线挽救治疗的疗效和安全性进行分析。结果 HGBL伴C-myc/BCL2/BCL6基因重排患者给予R-CHOP-like方案序贯Pola-R-CHP方案一线治疗4个周期后出现疾病进展；二线R-DICE-like方案联合塞利尼索挽救治疗未达客观缓解。基于高肿瘤负荷状态且对传统化疗反应不佳，三线选择格菲妥单抗，治疗3个周期后，疗效评价为部分缓解。格菲妥单抗首次给药后，患者出现高热，通过对淋巴细胞亚群及细胞因子水平的动态监测，判断为2级细胞因子释放综合征，给予托珠单抗干预后症状得到缓解。结论 对于多重耐药的HGBL患者，格菲妥单抗作为后线挽救治疗可能带来临床获益，但需警惕不良反应的发生，建议治疗期间实施密切监测。

Abstract:

Objective To evaluate the efficacy and safety of glofitamab as a later-line salvage therapy in patients with high-grade B-cell lymphoma (HGBL) harboring C-myc/BCL2/BCL6 rearrangements.Methods Using a case report integrated with literature analysis, we analyzed a 55-year-old female HGBL patient with C-myc/BCL2/BCL6 rearrangements who received third-line glofitamab (CD20×CD3 bispecific antibody).Results The patient underwent sequential frontline therapy consisting of an R-CHOP-like regimen followed by Pola-R-CHP for four cycles before developing disease progression. Second-line therapy with R-DICE-like plus selinexor failed to achieve objective response. Given high tumor burden and suboptimal response to conventional chemotherapy, glofitamab was administered as third-line therapy, achieving partial response after three treatment cycles. Following initial glofitamab infusion, grade 2 cytokine release syndrome manifested with high fever, which was managed by tocilizumab after dynamic monitoring of lymphocyte subsets and cytokine levels.Conclusion Glofitamab may provide clinical benefits in multi-drug resistant HGBL as a salvage therapy, but requires vigilant adverse event monitoring with intensive clinical surveillance.