RESUMO
Anaplastic lymphoma kinase-positive large B-cell lymphoma (ALK+ LBCL) is a rare subtype of non-Hodgkin lymphoma. ALK inhibitors are being tried to treat recurrent/refractory ALK+ LBCL. A majority of patients with ALK+ tumors respond to crizotinib, but partial cases ultimately develop resistance about a year later. Here, we report a case of ALK+ LBCL carrying a new fusion gene involving CDK14 and ALK, CLTC-ALK gene rearrangements and MTOR gene mutation. The patient had progressive disease after combination of crizotinib and chemotherapy treatment about 5.5 months later, accompanied by reduced abundance of CDK14-ALK, increased abundance of CLTC-ALK and a novel MFHAS1 gene mutation. However, MTOR mutation turned negative. The patient received alectinib combined with hyper-CVAD, then followed by alectinib as monotherapy for 21 months. The patient achieved partial response and remained in a stable condition. This case suggests that CDK14-ALK fusion gene may be more sensitive to crizotinib than CLTC-ALK fusion gene. MTOR is associated with the anti-tumor mechanism of ALK inhibitors. MFHAS1 gene mutation and/or CLTC-ALK gene copy number amplification may involve resistance to crizotinib. Furthermore, alectinib may inhibit the carcinogenicity of these gene changes and improve the prognosis of ALK+ LBCL.
The novel CDK14-ALK fusion gene in ALK+ LBCL was sensitive to crizotinib.MFHAS1 gene mutation and/or CLTC-ALK gene copy number amplification may involve resistance to crizotinib.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Linfoma de Células B , Humanos , Quinase do Linfoma Anaplásico/genética , Carbazóis/farmacologia , Carbazóis/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/patologia , Proteínas de Ciclo Celular/genética , Crizotinibe/farmacologia , Crizotinibe/uso terapêutico , Proteínas de Ligação a DNA/genética , Resistencia a Medicamentos Antineoplásicos/genética , Sequenciamento de Nucleotídeos em Larga Escala , Neoplasias Pulmonares/patologia , Linfoma de Células B/tratamento farmacológico , Mutação , Proteínas Oncogênicas/genética , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/uso terapêutico , Serina-Treonina Quinases TOR/genéticaRESUMO
An optical limiter was designed and fabricated. The device consists of an organic solution sandwiched between a polymer slab and a transparent relief polymer grating with a triangular groove. At low power the device has a high transmittance because the refractive index of the solution is matched with those of the slab and the grating materials and because the grating does not diffract. However, high power makes the organic solution thermally vaporize and makes the indices of the solution, slab, and grating materials become mismatched, which causes the grating to appear. The incident light is strongly absorbed, scattered, and self-defocused by the organic solution, and the grating suppresses the zero-order diffraction. Thus the transmitted light energy becomes lower than the damage threshold of human eyes or optical sensors. The device is an effective protection for human eyes or optical sensors against broadband pulsed-laser damage.