Primary spinal cord lymphoma rarely occurs, and the treatment strategy has not been standardized. Tirabrutinib (TIR) shows therapeutic efficacy for cases with primary central nervous system lymphoma (PCNSL) with B-cell pathology arising intracranially, but the evidence for primary spinal cord cases has not been reported. We present a case of primary spinal cord lymphoma successfully treated with TIR at relapse.

Case report.

A 58-year-old male presented with progressive numbness from the neck down and neck pain. Magnetic resonance imaging revealed an intramedullary lesion in the cervical spine from the cervico–medullary junction to the C7. Biopsy was performed, and the pathological diagnosis was diffuse large B-cell lymphoma. Four cycles of chemotherapy with rituximab, methotrexate, procarbazine, and vincristine (R-MPV) were ineffective, but remission of the cervical lesion was achieved after subsequent irradiation. However, after 1 month, a de novo lesion was observed in the lower thoracic spinal cord. Tumor remission was achieved with TIR, and the patient showed no relapse for 42 months after starting TIR.

TIR administration should be considered for relapsed primary spinal cord lymphomas similar to those with intracranial occurrence.