OncoTargets and Therapy (May 2021)
Successful Management of a Patient with Refractory Primary Central Nervous System Lymphoma by Zanubrutinib
Abstract
Qiansong Cheng,1,2 Jing Wang,2 Chenglan Lv,2 Jingyan Xu2 1Department of Hematology, The Lu’an People’s Hospital, The Lu’an Hospital Affiliated to Anhui Medical University, Lu’an, Anhui, People’s Republic of China; 2Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of ChinaCorrespondence: Jingyan XuDepartment of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, People’s Republic of ChinaTel +86 025 68182222Email [email protected]: Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma, and the most frequent histological type is diffuse large B‐cell lymphoma (DLBCL). Bruton’s tyrosine kinase inhibitor (BTKi) has shown clinical activity in DLBCL. We herein report a 53-year-old man who presented with binocular diplopia, gait instability, dizziness and bucking. He was diagnosed with PCNSL by cranial magnetic resonance imaging (MRI) scan and brain biopsy. Next-generation sequencing (NGS) examination identified multiple genetic abnormalities. The patient was started on a high-dose methotrexate (HD-MTX)-based protocol for two courses. However, the patient developed disease progression. The patient’s phenotypic and genetic characteristics strongly suggested BN2-DLBCL, and zanubrutinib was added to the subsequent chemotherapy regimen. The treatment was well tolerated, and complete remission (CR) was achieved after three courses of chemotherapy with the new regimen. The patient then received autologous hematopoietic stem cell transplantation after four courses of chemotherapy with the new regimen. MRI revealed stable CR. Here, we report a successful case of refractory PCNSL treated with zanubrutinib. Small molecules, such as zanubrutinib, may be selectively integrated into first-line regimens of PCNSL to enhance curative effect and reduce recurrence.Keywords: primary central nervous system lymphoma, Bruton’s tyrosine kinase, zanubrutinib, targeted therapy
