CD20 monoclonal antibody(The First Affiliated Hospital of Soochow University)

Patients with R/R DLBCL (relapsed/refractory diffuse large B‐cell lymphoma) treated with rituximab‐based regimens often have a reduction in the expression level of CD20. Replacement of target proteins for new targeted chemotherapy has become a popular direction for the treatment of R/R DLBCL. To investigate whether Daratumumab can be an effective alternative to targeted agents as monotherapy or combination chemotherapy in patients with CD20‐CD38+ R/R DLBCL who have failed to respond to CD20 monoclonal antibody treatment and its adjuvant effect on subsequent CAR‐T (chimeric antigen receptor T‐cell immunotherapy). A total of four CD20‐CD38+ R/R DLBCL patients treated with multiple lines of Daratumumab‐based combination chemotherapy were retrospectively collected. For eligible patients, CAR‐T therapy was used afterwards. Also, the authors successfully constructed allografted tumour models in mice. Relevant evaluation showed that four patients who received Daratumumab combination chemotherapy had varying degrees of remission after treatment, including 2 CR, 1 PR and 1 SD. The 1‐year OS rate was 75%, the 1‐year PFS rate was 50% and mOS was 12 months. Adverse effects were moderate and reversible, and no treatment‐related deaths occurred. Daratumumab therapy led to a successful transition to CAR‐T in two patients. Among them, grade 1 CRS occurred. These cases demonstrated that Daratumumab combination therapy has a good application prospect in the treatment of CD20‐CD38+ R/R DLBCL and is helpful for the bridge of CAR‐T therapy.

Letermovir (LTV) effectively prevents cytomegalovirus (CMV) reactivation in CMV‐seropositive patients. To evaluate the impact of LTV in matched sibling haematopoietic stem cell transplantation (HSCT) recipients, we retrospectively compared 72 matched sibling transplantation recipients receiving LTV with 134 controls. LTV significantly reduced 200‐day CMV viraemia incidence (5.6% vs. 33.3%, p < 0.001). Multivariable analysis identified anti‐thymocyte globulin (ATG) use (p = 0.005) and grade III–IV acute graft‐versus‐host disease (aGVHD; p < 0.001) as independent risk factors for CMV viraemia, while CMV serostatus did not significantly affect CMV viraemia (p = 0.448). Stratification based on risk factors (ATG, grade III–IV aGVHD) showed that LTV had a more significant effect on high‐risk patients compared to low‐risk patients. Also, LTV prophylaxis was associated with increased Epstein–Barr virus (EBV) viraemia (13.9% vs. 1.4%, p = 0.025) and higher CD20 monoclonal antibody utilization (11.1% vs. 1.4%, p = 0.046). Long‐term survival remained similar between both groups. Results were validated in a second cohort from our centre. In conclusion, LTV prophylaxis significantly reduced CMV viraemia, especially in high‐risk patients (ATG/grade III–IV aGVHD). However, the LTV group showed an elevated risk of EBV‐related complications. Risk stratification—rather than CMV serostatus alone—should guide CMV prevention strategies in matched sibling HSCT. Larger clinical studies are needed for validation.