Disease Control and Manageable Toxicity With Epcoritamab in Refractory Diffuse Large B-Cell Lymphoma-Type Richter Syndrome: A Case Report in an Elderly Patient

IF 1.9 Q4 ONCOLOGY

Cancer reports Pub Date : 2025-09-16 DOI:10.1002/cnr2.70349

Takumi Nishikawa, Masuho Saburi, Shogo Urabe, Eiichi Ohtsuka

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Abstract

Background

Richter syndrome (RS) is an aggressive transformation of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) with poor prognosis. No standard treatment for RS has been established. Epcoritamab, a CD3xCD20 bispecific antibody, may offer clinical benefit.

Case

An 80-year-old woman was diagnosed with SLL in 2017 and remained untreated for nearly 6 years. In 2023, she developed a bulky abdominal tumor. Although the initial biopsy showed SLL progression without transformation, subsequent treatments with acalabrutinib, venetoclax plus rituximab, and bendamustine plus rituximab failed. In 2024, transformation to diffuse large B-cell lymphoma-type RS (DLBCL-RS) was confirmed. Two lines of cytotoxic regimens were ineffective, with rapid tumor growth. Epcoritamab was initiated as third-line therapy. Grade 1–3 cytokine release syndrome occurred but resolved with standard management. No neurotoxicity was observed. Partial response (PR) was achieved by week 12, and the patient has maintained PR for 10 months. Infections including COVID-19 and cytomegalovirus were managed successfully, and immunoglobulin replacement was introduced for hypogammaglobulinemia.

Conclusion

This case highlights the potential of epcoritamab as an important treatment option for elderly patients with refractory DLBCL-RS.

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Epcoritamab治疗难治性弥漫性大b细胞淋巴瘤型Richter综合征的疾病控制和可控制的毒性：1例老年患者报告

背景：Richter综合征（RS）是一种侵袭性转化的慢性淋巴细胞白血病(CLL)/小淋巴细胞淋巴瘤（SLL），预后较差。目前还没有针对RS的标准治疗方法。Epcoritamab是一种CD3xCD20双特异性抗体，可能会带来临床益处。案例：一名80岁的女性于2017年被诊断出患有SLL，并未接受治疗近6年。2023年，她的腹部出现了一个巨大的肿瘤。虽然最初的活检显示SLL进展无转化，但随后的阿卡鲁替尼、venetoclax加利妥昔单抗和苯达莫司汀加利妥昔单抗治疗均失败。2024年确诊为弥漫性大b细胞淋巴瘤型RS （DLBCL-RS）。两种细胞毒方案无效，肿瘤生长迅速。Epcoritamab开始作为三线治疗。发生1-3级细胞因子释放综合征，但通过标准管理解决。未观察到神经毒性。第12周达到部分缓解（PR），并维持了10个月。包括COVID-19和巨细胞病毒在内的感染得到了成功的控制，并引入了免疫球蛋白替代治疗低丙种球蛋白血症。结论：该病例强调了依可他单抗作为难治性DLBCL-RS老年患者重要治疗选择的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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