Polatuzumab vedotin as first-line treatment for elderly intestinal diffuse large B-cell lymphoma:a case report
ZHENG Ruirui
WU Tao
MA Ruiqi
ZOU Caizu
BAI Jiaofeng
Abstract：Objective To observe the efficacy of polatuzumab vedotin as a first-line treatment for primary intestinal diffuse large B-cell lymphoma(PI-DLBCL)in elderly patients.Methods A retrospective analysis was conducted on the clinical data of one elderly patient with PI-DLBCL.Results A 71-year-old male patient presented with abdominal disten-sion of unknown cause.Abdominal CT scan suggested small bowel malignancy with extensive peritoneal metastasis;small bowel lymphoma remained to be ruled out.PET-CT scan suggested possible lymphoma,while small bowel malignancy with metastasis remained to be excluded.Pathological examination of a peritoneal biopsy confirmed a malignant tumor.Immu-nohistochemical staining yielded the following results:CK(-),Vimentin(-),CD20(diffuse+),CD3(-),INSM1(-),Ki67(approximately 90%+),CD79α(diffuse+),CD5(-),CD10(+),Bcl2(-),Bcl6(+),c-Myc(approximately 40%+),CD21(+).Combined with the pathological and immunohistochemical findings,the diagnosis was consistent with diffuse large B-cell lymphoma(DLBCL).Fluorescence in situ hybridization(FISH)analysis demonstrated negative re-sults for rearrangements in Bcl2,Bcl6,and c-Myc.Based on comprehensive assessment,the final diagnosis was primary intestinal DLBCL(PI-DLBCL),germinal center B-cell-like subtype,stage IV,with an International Prognostic Index(IPI)score of 5,placing the patient in the high-risk group.Upon diagnosis confirmation,the patient received two cycles of the Pola-R regimen(rituximab 600 mg IV on day 1,polatuzumab vedotin 90 mg IV on day 2),followed by one cycle of the Pola-R-CHOP regimen(polatuzumab vedotin 90 mg IV on day 0,rituximab 600 mg IV on day 1,cyclophosphamide 1.0 g IV on day 2,pirarubicin 40 mg IV on day 2,vinorelbine 40 mg IV on day 2,and prednisone acetate 60 mg orally on day 2-6).The treatment course was uneventful,and the patient achieved complete remission.Conclusions PI-DLBCL is a malignant tumor originating from intestinal lymphocytes,characterized by non-specific clinical manifestations and a predisposition to complications such as perforation,hemorrhage,and obstruction.First-line treatment for PI-DLBCL pri-marily involves surgery combined with chemotherapy,though no optimal therapeutic regimen has been established.In this case,for a treatment-naive,elderly patient with high-risk stratification who was unsuitable for surgery,the first-line che-motherapy regimen containing polatuzumab vedotin demonstrated a favorable therapeutic outcome.
Keywords：diffuse large B-cell lymphomaNon-Hodgkin's lymphomachemotherapypolatuzumab vedotin
Publication Date：2025-10-25
Online Publishing Date：2025-11-20(First online date of this platform, not the publication date of the document)
Pages：4( 72-75 )