[CAR-T therapy in elderly patients with relapsed/refractory diffuse large B-cell lymphoma. Clinical case of the San Martino Hospital in Genoa.]

Abstract

CAR-T therapy (chimeric antigen receptor T-cell) has revolutionized the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) that have relapsed or are refractory to conventional chemotherapies. In particular, patients who have relapsed or are refractory to two lines of therapy are patients who have a poor prognosis. The advent of CAR-T immunotherapy is an innovative approach with which we can give hope of recovery even in the case of refractory disease, even for patients who are not candidates for high-dose therapies, for example due to age. Here we present a clinical case of a 74-year-old patient at second relapse, refractory to two lines of chemotherapy and subjected to third-line CAR-T with axicabtagene ciloleucel, after a good response to bridge therapy with rituximab polatuzumab and bendamustine (RPB). Complete remission of the disease still persists eleven months after treatment. Tolerance to CAR-T was excellent, with grade 1 cytokine release syndrome (CRS), no neurological complications (ICANS-immune effector cell-associated neurotoxicity syndrome) and no infectious complications. Severe hypogammaglobulinemia persists eleven months after CAR-T reinfusion, for which he still performs immunoglobulin replenishment for prophylactic purposes.