Skill Checkup: A 74-Year-Old Woman With a History of Treated Diffuse Large B-Cell Lymphoma Has Fatigue and Splenomegaly

Zachary Cohn, MD


March 30, 2023

Patients with CNS involvement are not considered candidates for CAR T-cell therapy because of concerns regarding the risk for neurologic toxicity associated with treatment; patients with CNS involvement have been excluded from the pivotal clinical trials. In this case, the patient's PET/CT results did not show any evidence of CNS involvement, so she would not be excluded on that basis.

Responses to CAR T-cell therapy have been seen across all subgroups, including both GCB and non-GCB subtypes, and in patients with either relapsed or primary refractory disease. CD19 expression did not correlate with response rate in the clinical trials supporting the approval of currently available agents.

The patient's history of COPD is not relevant as long as she has adequate performance status to undergo treatment. Required pretreatment evaluations include both cardiac and neurologic evaluations, given the potential toxicities associated with CAR T-cell therapy.


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