Frontiers | Case Report: Diagnostic pitfall and biomarker-guided therapy in CD20-negative Epstein‑Barr virus-positive diffuse large B‑cell lymphoma

Rákkutatás · Diffuse large B-cell lymphoma

A biomarker‑driven strategy combining CD30‑targeted therapy and PD‑1 blockade achieved a complete metabolic response.

De novo CD20‑negative Epstein‑Barr virus–positive diffuse large B‑cell lymphoma, not otherwise specified (EBV+ DLBCL, NOS), is a rare subtype of DLBCL. CD20 loss complicates both diagnosis and treatment by limiting anti‑CD20 antibody use and broadening differential diagnosis. We report a case where comprehensive immunophenotypic and molecular analyses enabled accurate diagnosis. A biomarker‑driven strategy combining CD30‑targeted therapy and PD‑1 blockade achieved a complete metabolic response. This case underscores the importance of biology‑based individualized treatment in EBV‑associated lymphomas and the need for prospective studies of CD20‑independent strategies in high‑risk patients.

In cases of CD20‑negative EBV‑positive diffuse large B‑cell lymphoma (DLBCL), anti‑CD20 therapies such as rituximab are ineffective because the target antigen is lost. Therefore, identifying alternative surface markers (e.g., CD30) and immune checkpoints (PD‑1/PD‑L1) that are expressed on the tumor allows clinicians to design a focused treatment strategy that is more likely to be effective. This case demonstrates that a combination of a CD30‑directed antibody drug conjugate (brentuximab vedotin) with a PD‑1 inhibitor (tislelizumab) and a reduced‑intensity chemotherapy backbone (CHP) can achieve a durable complete metabolic response even when CD20 is absent, illustrating a rational and clinically feasible biomarker‑guided approach for this rare lymphoma subtype.

Bizonyítékszint: Klinikai vizsgálat. Formális klinikai vizsgálati eredmény.

Eredeti forrás

Kapcsolódó jelek