[CAR-T: an effective option in primary refractory patients]

Chimeric Antigen Receptor T-cell (CAR-T) therapy has significantly improved the prognosis of patients with diffuse large B-cell lymphoma (DLBCL), setting as the new standard of care. Below, we describe the case history of a 69-year-old female patient diagnosed with DLBCL, treated in 2024 with axi-cel for refractory disease to first-line with R-CHOP, after bridging therapy with PolaBR and associated radiotherapy. 18F-FDG-PET scan performed one month after CAR-T therapy showed complete remission of the lymphoma, and the patient is still in remission, at more than one year after the infusion. Patient treatment after infusion required the management of a CRS and ICANS requiring tocilizumab for CRS and subsequently dexamethasone for the ICANS, with rapid resolution of symptoms. This experience confirms the potential efficacy of axi-cel in a very extensive, symptomatic, and chemorefractory disease, and is very informative due to the specific immuno-effector T cell toxicities that occurred, both for the importance of their recognition and for the importance of their early treatment. These factors now ensure that safety considerations are no longer a barrier to offering the most effective treatment to this group of patients.