Immunoterapia cellulare CAR-T nella recidiva precoce post-chemio-immunoterapia di induzione

CAR-T therapies represent a major advance in the management of large B-cell lymphomas. Axi-cel, the only product approved in Italy as a second-line treatment, demonstrated superiority over standard therapy in the randomized phase 3 ZUMA-7 trial. We report the case of a 66-year-old woman with large B-cell lymphoma, diagnosed at stage IV with a high disease burden. After achieving complete remission with first-line R-CHOP, she experienced an early relapse at 6 months. She was therefore selected for axi-cel CAR-T therapy, preceded by leukapheresis and one cycle of R-DHAP, resulting in a partial response. The patient developed only grade 1 CRS and grade 1 early ICANS, both easily managed. PET scans at 1, 3, and 6 months showed a complete metabolic response, which is ongoing with no long-term toxicities. This case underscores the importance of close follow-up and timely CAR-T eligibility in high-risk patients.Key words. Axi-cel, CAR-T, LBCL, second line.