Chidamide combined with ibrutinib improved the prognosis of primary bone marrow diffuse large B cell lymphoma

Abstract

<jats:p> Primary bone marrow diffuse large B cell lymphoma (DLBCL) is an independent pathologic type with a poor prognosis when treated with standard chemoimmunotherapy. Generally, rituximab-based high-dose chemotherapy regimens such as dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) can be administered to young patients, followed by autologous stem cell transplantation. For elderly patients, the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) regimen is well tolerated, but it is an insufficient induction therapy for this group. Herein, we reported an elderly patient diagnosed with primary bone marrow DLBCL, germinal center B-cell-like subtype. Considering tolerance, the R-CHOP regimen was administered. However, his disease progressed after two treatment cycles. Then, the rituximab, gemcitabine, dexamethasone, cisplatin, lenalidomide regimen was administered, but the patient still experienced disease progression. Subsequently, the histone deacetylase (HDAC) inhibitor chidamide and Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib were concurrently administered, and the patient achieved complete remission. We found that the response of primary bone marrow DLBCL to chemotherapy was poorer than that of de novo DLBCL. High-dose chemotherapy regimens such as DA-EPOCH should be administered to young patients in combination with rituximab. For elderly patients, new targeted drugs such as HDAC and BTK inhibitors appear to produce favorable outcomes. </jats:p>

Case Report: Dual Inhibition of HDAC and BTK for Diffuse Large B-Cell Lymphoma After Failure to CD19-Targeted CAR-T Therapy

“…The regimen was well tolerated and the patient again achieved remission. Similarly, it was reported that combination treatment with chidamide and ibrutinib produced complete remission in a patient with primary refractory DLBCL (12). Nevertheless, the mechanism underlying the synergistic mechanism remains unclear.…”

“…Zanubrutinib, a second-generation BTKi, produced an ORR of 29% and a CR rate of 17% in R/R DLBCL regardless of molecular subtype (11). In preclinical experiments and case reports, dual inhibition of HDAC and BTK showed a possible synergistic effect for DLBCL (12,13).…”

Aggressive Diffuse Intermediate Size B-Cell Lymphoma With P53 Mutation Presented as Primary Bone Marrow Lymphoma

“…There were 51 high-grade BCL cases, and among these 77% (48/62) were DLBCL and 5% (3/62) were left unclassifiable. 1,3,5-33 Meanwhile, there were 11 cases of low-grade BCL, and 11% (7/62) were FLs. 1,34,35 According to the character of our case, we focused more on the analysis of HGBL.…”