A Case Report And Literature Review Of Follicular Lymphoma With TP53 Mutated Transformed Into Diffuse Large B Cell Lymphoma

Objective: To explore the clinical characteristics,related factors,management,and prognosis of patients with follicular lymphoma(FL)that transformed into diffuse large B cell lymphoma(DLBCL)to increase understanding about this type of lymphoma and provide clinical evidence for its treatmentMethods: The clinical data of a patient with FL with TP53 mutation transformed to DLBCL during the course of the disease were analyzed along with a literature review.Results: In this case of FL with TP53 mutation,a complete response had been achieved with two cycles of conventional R-CHOP chemotherapy.The disease progressed rapidly after two subsequent cycles of chemotherapy with the original regimen where the pathological diagnosis of transformation to DLBCL was established.After transformation,the patient appeared sensitive to the second-line chemotherapy regimen(R-ICE)and was scheduled to undergo autologous stem cell transplantation(ASCT).However,during preparation for the transplantation,the disease progressed again within 6 months.After one cycle of chemotherapy(R-DHAP),the patient developed right peripheral facial paralysis and left leg hypotonia.Antiviral treatment and high-dose methotrexate combined with temozolomide,followed by rituximab combined with high-dose methotrexate and cytarabine and two intrathecal injections were administered.However,the patient’s symptoms did not improve,and the primary disease was assessed as nonresponsive to the treatment.The patient eventually switched to CD19 chimeric antigen receptor T cell(CAR-T)therapy that resulted in continuous response for 1 year and 3 months.At present,the patient is being followed up.Conclusion: FL with TP53 mutation is characterized by a poor response to chemotherapy,rapid disease progression,and possible transformation to DLBCL in a short duration.TP53 mutation is the independent risk factors for poor prognosis of FL.CD19CAR-T therapy is efficacious for transformed refractory DLBCL.For FL with TP53 mutation,CD19 CAR-T therapy could improve the prognosis and significantly extend theprogression-free survival(PFS)and improve the overall survival(OS)of the patient.