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

Area of Science:

• Oncology
• Immunotherapy
• Hematology

Background:

• Diffuse large B-cell lymphoma (DLBCL) is a common non-Hodgkin lymphoma.
• Chimeric Antigen Receptor T-cell (CAR-T) therapy has emerged as a promising treatment for relapsed or refractory DLBCL.
• Standard first-line treatment for DLBCL is R-CHOP, but refractory cases require alternative strategies.

Purpose of the Study:

• To report a case of successful CAR-T therapy with axi-cel in a patient with refractory DLBCL.
• To highlight the management of immune-related toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).
• To underscore the safety and efficacy of axi-cel in extensive and chemorefractory disease.

Main Methods:

• A 69-year-old female patient with DLBCL refractory to R-CHOP received bridging therapy with PolaBR and radiotherapy.
• Axicabtagene ciloleucel (axi-cel) CAR-T therapy was administered.
• Management of CRS with tocilizumab and ICANS with dexamethasone was performed.
• 18F-FDG-PET scans were used for response assessment.

Main Results:

• The patient achieved complete remission one month after axi-cel infusion, confirmed by 18F-FDG-PET scan.
• Sustained remission was observed for over one year post-infusion.
• CRS and ICANS were successfully managed with tocilizumab and dexamethasone, respectively, leading to rapid symptom resolution.

Conclusions:

• Axicabtagene ciloleucel (axi-cel) demonstrates significant efficacy in patients with extensive, symptomatic, and chemorefractory diffuse large B-cell lymphoma (DLBCL).
• Prompt recognition and management of immune-related toxicities like CRS and ICANS are crucial for patient safety and treatment success.
• CAR-T therapy, with appropriate safety monitoring, is a viable and effective option for challenging DLBCL cases.