[ALK阳性难治性无性大细胞淋巴瘤异基因干细胞移植前使用阿来替尼的桥接疗法获得成功]。

Asuka Kono, Keisuke Tanaka, Tomohito Shimada, Kana Bando, Atsushi Takahata, Satoshi Koi, Masahide Yamamoto, Takehiko Mori, Shigeo Toyota
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引用次数: 0

摘要

虽然阿来替尼对复发或难治性ALK阳性无性大细胞淋巴瘤(ALCL)有效,而且安全性良好,但它作为异基因造血干细胞移植(allo-HSCT)的桥接疗法以及allo-HSCT本身在这种情况下的作用尚不清楚。一名35岁的ALK阳性ALCL患者在接受CHOP一线治疗后复发。布伦妥昔单抗维多汀导致部分反应,并进行了大剂量化疗联合自体造血干细胞移植。然而,移植后15个月病情出现进展,于是开始使用阿来替尼。治疗三个月后获得了完全应答(CR),阿来替尼继续治疗了五个月。停止阿来替尼治疗后,患者在接受氟达拉滨、丁仲氨嘧啶和全身照射调理后,从HLA 1位点不匹配的非亲属供者处接受了异基因骨髓移植。预防GVHD的药物包括他克莫司和短期甲氨蝶呤。移植后的疗程除出现 I 级急性 GVHD 外,其他情况均无异常。在异基因造血干细胞移植后的两年里,淋巴瘤没有复发,也没有恢复阿来替尼治疗。我们病例的临床过程表明,阿来替尼桥接疗法和allo-HSCT对复发/难治性ALK阳性ALCL有效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Successful bridging therapy with alectinib prior to allogeneic stem cell transplantation for refractory ALK-positive anaplastic large cell lymphoma].

Although alectinib is effective for relapsed or refractory ALK-positive anaplastic large cell lymphoma (ALCL) and has a favorable safety profile, its role as a bridging therapy for allogeneic hematopoietic stem cell transplantation (allo-HSCT) and the role of allo-HSCT itself in this setting are unknown. A 35-year-old man with ALK-positive ALCL experienced relapse after first-line therapy with CHOP. Brentuximab vedotin led to partial response and high-dose chemotherapy combined with autologous HSCT was performed. However, disease progressed 15 months after transplantation, and alectinib was initiated. Complete response (CR) was achieved after three months of treatment, and alectinib was continued for 5 months. After cessation of alectinib, allogeneic bone marrow transplantation from an HLA 1-locus mismatched unrelated donor was performed after conditioning with fludarabine, busulfan, and total body irradiation. GVHD prophylaxis consisted of tacrolimus and short-term methotrexate. The post-transplant course was unremarkable except for grade I acute GVHD. The lymphoma has not recurred for 2 years after allo-HSCT without resuming alectinib. The clinical course of our case suggests that alectinib bridging therapy and allo-HSCT are effective in relapsed/refractory ALK-positive ALCL.

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