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

作　　者：姚嘉瑞 唐乐 刘鹏 YAO Jiarui;TANG Le#;LIU Peng(Department of Medical Oncology,Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院内科抗肿瘤分子靶向药物临床研究北京市重点实验室,北京100021

出　　处：《肿瘤药学》2025年第1期124-129,共6页Anti-Tumor Pharmacy

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。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.

关 键 词：高级别B细胞淋巴瘤 C-myc/BCL2/BCL6重排 格菲妥单抗 疗效 安全性 

分 类 号：R733.4[医药卫生—肿瘤]