A rare subtype of aggressive large B-cell lymphoma( PBL ) has a poor prognosis despite receiving aggressive therapies. For those with refractory disease, new methods are required. Similar to multiple myeloma ( MM ), PBL expresses antigens like B – cell maturation ( BCMA ). In a phase Ib / II trial, chimeric antigen receptor T-cell( CAR-T ) therapy directed against BCMA has demonstrated efficacy for the treatment of heavily pretreated MM with low rates of grades 3 and 4 cytokine release syndrome( CRS ) and immune effector cell-associated neurotoxicity syndrome. However, there aren’t enough data to use BCMA CAR – T for treating PBL.
We describe a difficult case of multiple refractory PBL that developed from acute B-cell lymphoblastic leukemia in an adult who was unable to recover from an allogeneic hematopoietic cell transplant. Despite the patient’s withdrawal of immunosuppression, treatment with etoposide, ibrutinib, and daratumumab and the rapid progression of the disease, BCMA CAR – T( under emergency investigational new drug ( eIND )) was taken into consideration. After receiving BCMA CAR-T therapy, the patient experienced a complete remission ( CR ), without the need for additional acute grafts against host disease( GVHD ), CRS, or ICANS. In vivo, BCMA CAR-T expansion was noticed, reaching its peak on day 15. The patient stays in CR for more than a year after receiving CAR-T therapy, which encourages future patients with refractory PBL — a condition with few treatment options — to think about immunotherapy.