Efficacy of PR2-based immunotherapy in the treatment of diffuse large B-cell lymphoma-associated neurolymphomatosis: A report on two cases

Neurolymphomatosis (NL) is a rare manifestation of lymphoma resulting from the infiltration of malignant lymphoma cells into the peripheral nervous system. When evaluating peripheral neuropathy, clinical suspicion of NL is highly necessary because its clinical symptoms vary and pathological diagnosis is often difficult. Imaging modalities carry a high sensitivity to diagnose NL. 18 F-flurodeoxyglucose positron emission tomography-computed tomography (18 F-FDG PET/CT), with a diagnostic sensitivity of over 90%, as well as Magnetic resonance imaging (MRI) neurography, has become the leading diagnostic modalities for NL diagnosis, staging, and treatment response assessment. At present, the prognosis of NL is usually poor, and its treatment is also challenging, with few patients benefiting from the currently available treatment measures. The present report discusses two cases of diffuse large B-cell lymphoma-associated NL. They presented with painful polyneuropathy/polyradiculopathy, and imaging examinations such as MRI and 18 F-FDG PET/CT indicated related neuropathy. Both cases were treated with PR2-based immunotherapy (anti-PD-1 tirelizumab 200 mg d1, rituximab 375 mg/m² d0, and lenalidomide 25 mg d1-14). And clinical efficacy was observed, with improved symptoms. Imaging studies showed a significant reduction in lesions of the cervical plexus nerve roots, lumbosacral nerve, sciatic nerve, and brachial plexus. In this study, the two cases of NL with typical clinical and imaging manifestations discussed in the present report exhibited good clinical efficacy after receiving PR2-based immunotherapy. These results provide insights into the development of a novel, potentially effective treatment option for patients with NL.