Relapsed or refractory (R/R) large B cell lymphoma (LBCL) presenting as secondary central nervous system lymphoma (SCNSL) carries a poor prognosis, with a median survival time of two to five months. Chimeric antigen receptor (CAR)-T cell therapy has been approved in R/R LBCL, but studies are ongoing to understand its efficacy and safety for SCNSL. Axicabtagene ciloleucel or tisagenlecleucel have been shown to attain high response rates in some retrospective studies; however, response durability continues to be unclear. Our study is a case series of three patients with R/R SCNSL who were treated with tisagenlecleucel. One patient achieved a complete response 30 days after CAR-T therapy but developed disease progression on day +100 imaging. The second patient had a partial response and eventual disease progression with ultimately death. The third patient died from central nervous system complications of CAR-T therapy. Two of the three patients developed immune effector cell-associated neurotoxicity syndrome grade 4 and cytokine release syndrome grade 1 toxicities. Our series of three patients demonstrates that R/R SCNSL can elicit a response with CAR-T therapy, although with a limited duration response.
Keywords: chimeric antigen receptor t cell therapy; double hit lymphoma; relapsed/refractory; secondary cns lymphoma; tisagenlecleucel.
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