Triplet Therapy with PD-1 Blockade, Histone Deacetylase Inhibitor, and DNA Methyltransferase Inhibitor Achieves Radiological Response in Refractory Double-Expressor Diffuse Large B-cell Lymphoma with 17p Deletion

Table 1

Treatment timescales.

	Start time	Therapy	Number of cycles	Time for repeat CT/PET	Effect
1^st	2019/7/19	R-EPOCH: rituximab, etoposide, vincristine, cyclophosphamide, doxorubicin, and dexamethasone	1	2019/8/8 (CT)	Stable disease
2^nd	2019/8/15	R-EPOCH + lenalidomide (25 mg d1-7) + ibrutinib (420 mg once a day)	1	2019/9/4 (PET)	Progressive metabolic disease
3^rd	2019/9/5	GDP (gemcitabine, DDP, and dexamethasone) + Sintilimab (200 mg d1) + Decitabine (10 mg d1-5)	1	2019/9/17 (CT)	Stable disease
4^th	2019/9/29	Sintilimab (200 mg, iv. d1) + Decitabine (10 mg, iv, d1-5) + Chidamide (20 mg, po, twice a week)	3.	2019/10/17 (PET)	Partial metabolic response and >90% shrinkage of mass
	2019/10/22
	2019/11/12			2019/11/26 (PET)	Progressive metabolic disease
5^th	2019/11/29	Radiotherapy (50 Gy) + Sintilimab (200 mg d1) + Chidamide (20 mg twice a week) + venetoclax	1	2020-2-5 (PET)	Progressive metabolic disease
	2020/2/10	Syngeneic stem cell transplantation		2020-3-25 (PET)	Complete metabolic response

CT, computed tomography; PET, positron emission tomography. Response assessment was made according to the Lugano classification [17]: Stable disease: <50% decrease from baseline in SPD of up to 6 dominant, measurable nodes, and extranodal sites; no criteria for progressive disease are met. Progressive metabolic disease: PET-CT Score 4 or 5 with an increase in intensity of uptake from baseline and/or new foci consistent with lymphoma at interim or end-of-treatment assessment. Partial metabolic response: PET-CT score 4 or 5 with reduced uptake compared with baseline and residual mass(es) of any size. Complete metabolic response: score 1, 2, or 3 with or without a residual mass on 5 PET-CT score.