Chimeric antigen receptor T-cell therapy following autologous transplantation for secondary central nervous system lymphoma: A case report.

Abstract

RATIONALE:

Chimeric antigen receptor (CAR) T-cell therapy is effective in treating relapsed and refractory B-cell non-Hodgkin lymphoma. However, because of the mortality risk associated with immune effector cell-associated neurotoxicity syndrome and pseudoprogression, patients with central nervous system (CNS) involvement are less likely to receive CAR T-cell therapy.

PATIENTS CONCERNS:

We report a case of a 61-year-old, male patient with intravascular large B-cell lymphoma who suffered a CNS relapse after standard chemotherapy.

DIAGNOSIS:

A diagnosis of intravascular large B-cell lymphoma with CNS involvement was made.

INTERVENTIONS:

We treated the patient using CAR T-cell therapy following a conditioning regimen consisting of thiotepa and busulfan and autologous stem cell transplantation. Although he experienced grade 1 cytokine release syndrome, no other serious adverse events, such as immune effector cell-associated neurotoxicity syndrome or pseudoprogression, were observed.

OUTCOMES:

The patient achieved complete remission after the CAR T-cell infusion.

LESSONS:

CAR T-cell therapy following autologous stem cell transplantation is a viable option for relapsed/refractory lymphoma with CNS infiltration. Further clinical studies are warranted to verify its safety and efficacy.

• Authors: Yu Yagi, Yusuke Kanemasa, An Ohigashi, Yuka Morita, Taichi Tamura, Shohei Nakamura, Yuki Otsuka, Yuya Kishida, Akihiko Kageyama, Takuya Shimizuguchi, Takashi Toya, Hiroaki Shimizu, Yuho Najima, Takeshi Kobayashi, Kyoko Haraguchi, Noriko Doki, Yoshiki Okuyama, Yasushi Omuro, Tatsu Shimoyama
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 44 Pg. e27733 (Nov 05 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 34871273 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Receptors, Antigen, T-Cell
• Receptors, Chimeric Antigen

Topics

• Central Nervous System
• Central Nervous System Neoplasms (therapy)
• Hematopoietic Stem Cell Transplantation
• Humans
• Immunotherapy, Adoptive (methods)
• Lymphoma, Large B-Cell, Diffuse (therapy)
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Neoplasms, Second Primary (therapy)
• Neurotoxicity Syndromes
• Receptors, Antigen, T-Cell
• Receptors, Chimeric Antigen
• Transplantation, Autologous (adverse effects)