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Leo I. Gordon, MD, FACP


Case Report Features Novel Therapeutic Strategy for Chemotherapy-Resistant DLBCL

By: Joshua D. Madera, MS
Posted: Monday, March 13, 2023

For patients with chemotherapy-resistant diffuse large B-cell lymphoma (DLBCL), the use of an in vitro high-throughput drug sensitivity test may illuminate effective therapeutic drugs to achieve a complete response, according to a case report published in Frontiers in Oncology. However, prospective clinical trials assessing the efficacy of this strategy are necessary, explained Zengjun Li, MD, PhD, of Shandong Cancer Hospital and Institute, China, and colleagues.

A 30-year-old female presented with a nontender anterior neck mass that had rapidly progressed in size over 1 month. She had not experienced any other symptoms. On physical exam, multiple, firm, fixed, and nontender lymph nodes were identified in the patient’s neck. An 18F-fluorodeoxyglucose (18F-FDG)-PET revealed increased uptake in multiple lymph nodes near the carotid sheath. This finding prompted immunohistochemical analysis of the collected pathologic biopsy, which led to a diagnosis of DLBCL with overexpression of the genes MYC and BCL2.

Two cycles of combination therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone, and zanubrutinib led to a partial response, which remained consistent through a total of four cycles. However, after six treatment cycles, the patient experienced disease progression, as indicated by enlarged lymph nodes in the right neck and tonsil and confirmed by 18F-FDG-PET.

Given the patient’s worsening status, a multidisciplinary team was assembled to discuss the possibility of an in vitro high-throughput drug sensitivity test. Although this therapeutic measure was still in the experimental stage, the patient agreed to an attempt, which revealed tumor cell sensitivity to bortezomib, thalidomide, and gemcitabine as single-treatment agents and to combination therapy with bortezomib, thalidomide, and dexamethasone (VTD). Following treatment with four cycles of VTD, the patient achieved a complete response with no adverse events reported.

Disclosure: The study authors reported no conflicts of interest.

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