Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 May 24:14:3367-3372.
doi: 10.2147/OTT.S309408. eCollection 2021.

Successful Management of a Patient with Refractory Primary Central Nervous System Lymphoma by Zanubrutinib

Qiansong Cheng  1   2 , Jing Wang  2 , Chenglan Lv  2 , Jingyan Xu  2
Affiliations
Case Reports

Successful Management of a Patient with Refractory Primary Central Nervous System Lymphoma by Zanubrutinib

Qiansong Cheng et al. Onco Targets Ther. .

Abstract

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: Bruton’s tyrosine kinase; primary central nervous system lymphoma; targeted therapy; zanubrutinib.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
MRI scan of the brain at presentation. This MRI scan image showed two notable nodules in the cerebellopontine angle area and the medial temporal horn of the left ventricle (black arrow).
Figure 2
Figure 2
Treatment procedure, and timeline of symptoms during the treatment. MRI1, first MRI scan; MRI2, second MRI scan; MRI3, third MRI scan; MRI4, fourth MRI scan; bid, twice daily.
Figure 3
Figure 3
Cranial MRI images. (A and B) Cranial MRI imaging on admission to the department of hematology. (C and D) Cranial contrast-enhanced MRI imaging on the day before the third course showed that the mass in the cerebellopontine angle area had clearly enlarged. (E and F) Cranial contrast-enhanced MRI imaging on the day before the fourth course showed that the mass was reduced significantly. (G and H) Cranial contrast-enhanced MRI imaging on the day before the fifth course showed that the mass disappeared with cicatricial changes.
See this image and copyright information in PMC

References

    1. Villano JL, Koshy M, Shaikh H, Dolecek TA, McCarthy BJ. Age, gender, and racial differences in incidence and survival in primary CNS lymphoma. Br J Cancer. 2011;105(9):1414–1418. doi:10.1038/bjc.2011.357 - DOI - PMC - PubMed
    1. Grommes C, DeAngelis LM. Primary CNS lymphoma. J Clin Oncol. 2017;35(21):2410–2418. doi:10.1200/JCO.2017.72.7602 - DOI - PMC - PubMed
    1. Mendez JS, Grommes C. Treatment of primary central nervous system lymphoma: from chemotherapy to small molecules. Am Soc Clin Oncol Educ Book. 2018;38(38):604–615. doi:10.1200/EDBK_200829 - DOI - PubMed
    1. Younes A, Ansell S, Fowler N, et al. The landscape of new drugs in lymphoma. Nat Rev Clin Oncol. 2017;14(6):335–346. doi:10.1038/nrclinonc.2016.205 - DOI - PMC - PubMed
    1. Wilson WH, Young RM, Schmitz R, et al. Targeting B cell receptor signaling with ibrutinib in diffuse large B cell lymphoma. Nat Med. 2015;21(8):922–926. doi:10.1038/nm.3884 - DOI - PMC - PubMed

Publication types