PMC8312258_01
Baseline PET-CT and pathological images (A) PET-CT images of the patient; (B) pathological images of the tumor.
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Further fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) indicated multiple lymph node enlargements in the neck, clavicle, axilla, and bilateral inguen with a maximum standard uptake volume (SUV) of 31.2 ( Figure 1A ). Figure 1B ). Fluorescence in situ hybridization (FISH) analysis demonstrated no translocation of MYC, BCL2, and BCL6.
The treatment schedule and the change of cytokines, serum EBV-DNA and body temperature of the patient. (A) Flow chart of treatment; (B) the change of cytokines; (C) the change of EBV-DNA (D) the change of body temperature.
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Two weeks after lenalidomide, anti-PD-1 antibody tislelizumab was initiated at a dose of 200 mg every 3 weeks ( Figure 2A ). The cytokines presented transient increase ( Figure 2B ), and the patient presented a paroxysmal episode of transient atrial fibrillation (AF). Moreover, the level of serum EBV-DNA fluctuated throughout the treatment and eventually fell to an undetectable level with the continuation of tislelizumab ( Figure 2C ). The body temperature returned to a normal level after the first cycle of tislelizumab ( Figure 2D ).
The final PET-CT and enhanced CT evaluation of the patient. (A) The final PET-CT evaluation showed complete metabolism remission after eight cycles of tislelizumab and lenalidomide. (B) The enhanced CT evaluation showed complete remission 4 months after PET scan.
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Meanwhile, the lymph nodes of the patient palpably regressed after the first cycle of tislelizumab plus lenalidomide and had a PET evaluation with Deauville score 4 after four cycles and Deauville score 3 after eight cycles of tislelizumab plus lenalidomide ( Figure 3A ). Enhanced CT scan was performed 4 months after the final PET and confirmed the complete remission status of the patient ( Figure 3B ).