[Two cases of EB virus-positive diffuse large B-cell lymphoma with HAVCR2 mutation].

Zhonghua nei ke za zhi Pub Date : 2023-07-01 DOI:10.3760/cma.j.cn112138-20221018-00764

X Q Nie, C F Huang, Z Yin, Y Yang, X Zhou, D Fang, R Cao, Q F Liu, R Lin, Y J Deng, G P Yu

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Abstract

报道2例EB病毒（EBV）阳性弥漫性大B细胞淋巴瘤（DLBCL）伴HAVCR2突变患者。2例患者均无免疫缺陷病史，发病后均出现机会性感染，外周血T细胞绝对计数明显减少，T细胞和肿瘤组织高表达T细胞免疫球蛋白和黏蛋白结构域-3（TIM-3）；二代测序检出甲型肝炎病毒细胞受体2（HAVCR2）基因突变。1例患者接受了R-COP方案（利妥昔单抗、环磷酰胺、长春新碱、泼尼松）治疗效果欠佳，T细胞计数和功能未恢复，EBV未清除，总生存仅为7个月；另一例患者接受程序性死亡受体1（PD-1）抑制剂联合CHOP样方案（环磷酰胺、表柔比星、长春新碱、地塞米松）治疗获得完全缓解持续时间超过6个月，T细胞计数和功能恢复正常，EBV被清除。结合文献复习提示HAVCR2突变导致TIM-3过表达继发T细胞耗竭，获得性免疫缺陷导致EBV再激活可能与EBV阳性DLBCL的发生、发展密切相关；提示尽早使用免疫检查点抑制剂恢复免疫功能可能改善疗效。.

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