Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2021; 9(10): 2394-2399
Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2394
Programmed cell death protein-1 inhibitor combined with chimeric antigen receptor T cells in the treatment of relapsed refractory non-Hodgkin lymphoma: A case report
Zhi-Yun Niu, Li Sun, Shu-Peng Wen, Zheng-Rong Song, Lina Xing, Ying Wang, Jian-Qiang Li, Xue-Jun Zhang, Fu-Xu Wang
Zhi-Yun Niu, Li Sun, Shu-Peng Wen, Zheng-Rong Song, Lina Xing, Ying Wang, Xue-Jun Zhang, Fu-Xu Wang, Department of Hematology, Second Hospital of Hebei Medical University, Hebei Key Laboratory of Hematology, Shijiazhuang 050000, Hebei Province, China
Jian-Qiang Li, Central Laboratory, Hebei Senlang Biotechnology Co., Shijiazhuang 050000, Hebei Province, China
Author contributions: Wang FX conceptualized and designed the study; Niu ZY, Sun L and Wen SP performed the clinical trial; Xing LN, Li JQ, Song ZR and Wang Yacquired the data; Li JQ prepared the anti-CD19 CAR T-cells; Zhang XJ analyzed and interpreted the data; Niu ZY contributed to the writing and Wang FX revised the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Xu Wang, PhD, Professor, Department of Hematology, Second Hospital of Hebei Medical University, Hebei Key Laboratory of Hematology, Shijiazhuang 050000, Hebei Province, China. wfxhebmu@163.com
Received: December 15, 2020
Peer-review started: December 15, 2020
First decision: December 28, 2020
Revised: January 6, 2021
Accepted: January 28, 2021
Article in press: January 28, 2021
Published online: April 6, 2021
Abstract
BACKGROUND

Chimeric antigen receptor T cell (CART) therapy has benefited many refractory lymphoma patients, but some patients experience poor effects. Previous studies have shown that programmed cell death protein-1 (PD-1) inhibitors can improve and prolong the therapeutic effect of CAR-T cell treatment.

CASE SUMMARY

A 61-year-old male presented with 15-d history of diarrhea and lower-limb edema. A large mass was detected in the pelvis, and pathology indicated non-Hodgkin diffuse large B-cell lymphoma. After three cycles of the R-CHOP chemotherapeutic regimen, the patient showed three subcutaneous nodules under the left armpit and both sides of the cervical spine. Pathological examination of the nodules indicated DLBCL again. The patient was diagnosed with relapsed and refractory diffuse large B-cell lymphoma. We recommended CAR-T cell treatment. Before treatment, the patient’s T cell function and expression of immune detection points were tested. Expression of PD-1 was obviously increased (52.7%) on cluster of differentiation (CD)3+ T cells. The PD-1 inhibitor (3 mg/kg) was infused prior to lymphodepleting chemotherapy with fludarabine and cyclophosphamide. CAR-CD19 T cells of 3 × 106/kg and CAR-CD22 T cells 1 × 106/kg were infused, respectively. The therapeutic effect was significant, and the deoxyribonucleic acid copy numbers of CAR-CD19 T cells and CAR-CD22 T cells were stable. Presently, the patient has been disease-free for more than 12 mo.

CONCLUSION

This case suggests that the combination of PD-1 inhibitors and CAR-T cells improved therapeutic efficacy in B-cell lymphoma.

Keywords: Chimeric antigen receptor T cell, Programmed cell death protein 1 inhibitor, Relapsed/refractory non-Hodgkin lymphoma, Case report

Core Tip: The mechanism of early loss of chimeric antigen receptor T (CAR-T) cells may be the depletion of activated T cells due to stimulation of the immune checkpoint pathway [such as programmed cell death protein-1 (PD-1)] of lymphoma cells. Immune checkpoints have a critical role in the immune system. This case suggests that PD-1 expression may affect the therapeutic effect of CAR-T cell therapy, and combination CAR-T cells and a PD-1 inhibitor may be a viable treatment option for relapsed and refractory non-Hodgkin lymphoma.