CASE REPORT article
Front. Hematol.
Sec. Immunobiology and Immunotherapy
Volume 4 - 2025 | doi: 10.3389/frhem.2025.1616504
This article is part of the Research TopicThe Future of Cell Therapies WorldwideView all articles
Balance and management of CRS and infection following CD19-targeted CAR T-cell therapy in primary refractory high-grade B-cell lymphoma: A case report
Provisionally accepted
- 1Biotherapeutic Department, Chinese PLA General Hospital, Beijing, China
- 2Beijing Gao Bo Boren Hospital, Beijing, Beijing Municipality, China
- 3Department of Biotherapeutic, the Fifth Medical Center of the Chinese PLA General Hospital, Beijing, China
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Background: CD19-targeted chimeric antigen receptor T (CAR-T) cell therapy has transformed the treatment of refractory/relapsed B-cell malignancies but introduces significant safety concerns, including cytokine release syndrome (CRS) and infections, which can lead to life-threatening complications. However, as two complications with conflicting treatment approaches, balancing the treatment of these two complications also means balancing the safety and effectiveness of CAR T-cell therapy. How to balance and manage infections complicated by CRS was unknown.Case presentation: A 54-year-old man with primary refractory high-grade B-cell lymphoma, who had failed multiple prior therapies, received CD19 CAR T-cell therapy after bridging therapy and intensive lymphodepletion. He developed a severe diffuse alveolar hemorrhage induced by CRS complicated with virus infection following CAR T-cell infusion. Despite aggressive therapeutic approaches including anti-infection measures, immune modulation, and anti-cytokine agents, no significant clinical improvement was initially observed. Only after the introduction of glucocorticoids following the median time to peak CAR T-cell expansion, the patient's toxicity was effectively managed and he achieved a complete response (CR). The patient sustained a CR for over 36 months, until January 2025.Conclusion: This case highlights the importance of early diagnosis and management of CRS and infection after CAR T-cell therapy, offering critical insights into managing adverse reactions and optimizing patient outcomes.
Keywords: B-cell lymphoma, CAR T-cell therapy, cytokine release syndrome, herpesvirus infection, corticosteroids
Received: 22 Apr 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Lu, Zhang, Wang, Yang, Rong, Liu and Han. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Nannan Lu, Biotherapeutic Department, Chinese PLA General Hospital, Beijing, China
Yang Liu, Biotherapeutic Department, Chinese PLA General Hospital, Beijing, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.