Durable Response of Primary Cardiac Lymphoma After Autologous Stem Cell Transplantation and Sequential CAR-T Therapy: A Case Report and Literature Review

Ge Wang¹Xiaoxi Zhou^2,3Pengcheng Wang^4*Zekai Mao^2,3*

• ¹Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hebei Province, China
• ²Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
• ³Immunotherapy Research Center for Hematologic Diseases, Hubei Province, Wuhan, Hubei, China
• ⁴Emergency Center, Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, Wuhan, Hebei Province, China

Primary cardiac lymphoma (PCL), an exceedingly rare and aggressive extranodal lymphoma confined to the heart and/or pericardium, poses significant diagnostic and therapeutic challenges with historically dismal prognosis. We present the first documented case of PCL achieving sustained complete response (CR) through a novel therapeutic approach combining autologous hematopoietic stem cell transplantation (ASCT) with sequential tandem CD19/20 CAR-T therapy. A 55-year-old female presented with chest tightness and pericardial effusion in April 2023. The diagnostic process involved multiple modalities and analyses, culminating in a diagnosis via CT-guided mediastinal lymph node biopsy. The patient underwent several chemotherapy regimens, including combinations of rituximab and polatuzumab vedotin, R-CHOP, Pola-R-CHP, and Pola-R-DA-EPOCH, which led to symptom relief and a partial response. Subsequently ASCT was performed, followed by sequential tandem CD19/20 CAR-T therapy. As a maintenance treatment, PD-1 inhibitor, sintilimab was administered about every two months. The patient achieved CR at month 3 and maintained CR for one year since receiving the CAR-T infusion. Following CAR-T therapy, the patient developed immune effector cell-associated hematologic toxicity, but managed with granulocyte colony-stimulating factor injection and supportive care. This case illustrates the difficulties in diagnosing and treating PCL. Through the combination of ASCT and sequential tandem CD19/20 CAR-T therapy, the patient achieved sustained CR with manageable toxicity. This case demonstrates the feasibility, safety, and potential efficacy of this combination strategy in treating high-risk lymphoma. Moreover, we propose a structured algorithm that may help optimize the clinical implementation of CAR-T therapy in similar cases.Continued follow-up and broader studies are warranted to validate these findings.