CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
Case Report: CAR-T Therapy for Relapsed Diffuse Large B-Cell Lymphoma in a Patient with Pre-Existing Parkinson's Disease—Unfolding Clinical Challenges
Anas Ibraheem 1,2
Helena Vincentelli 1
Andrea Kuhnl 1
Emil A Kumar 1
Andres Moya Davila 1
Piers EM Patten 1,3
Deborah Yallop 1
Reuben Benjamin 1,3
Charlotte Graham 1,3
Aaron Niblock 4
Robin Sanderson 1
1. Department of Haematology, King's College Hospital, London, United Kingdom
2. Department of Oncology, The London Clinic, London, United Kingdom
3. Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Medicine, King's College London, London, United Kingdom
4. Northern Health Care and Social Trust, Antrim, Northern Ireland, United Kingdom
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Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy has transformed the outcomes for relapsed/refractory diffuse large B-cell lymphoma (DLBCL). However, immune effector cell–associated neurotoxicity syndrome (ICANS) remains a concern. Pre-existing neurological disorders such as Parkinson's disease (PD) introduce additional, poorly studied challenges due to the risk of unpredictable complications. We report a 62-year-old man with relapsed DLBCL and pre-existing PD who was treated with lisocabtagene maraleucel. Baseline assessments by neurology, physiotherapy, and speech-language teams enabled tailored monitoring, including use of a modified Immune Effector Cell–Associated Encephalopathy (ICE) score. His dopaminergic regimen was optimised prior to therapy. Following lymphodepletion and CAR-T infusion, he experienced grade 1 cytokine release syndrome, which resolved with tocilizumab and ward-based supportive care. Although a stable partial response was observed on PET-CT scan at 1 and 3 months, the absence of ICANS or PD worsening up to his most recent follow-up on Day +86 suggests that CAR-T therapy can be safely delivered in patients with pre-existing PD when tailored strategies are applied, including a multidisciplinary approach, modified neurotoxicity monitoring, and careful selection of the CAR-T construct. Further studies and longer follow-up are needed to clarify long-term safety in this population.
Summary
Keywords
CAR-T therapy, Diffuse large B-cell lymphoma (DLBCL), Immune Effector Cell–associated Neurotoxicity Syndrome (ICANS), multidisciplinary approach, parkinsonism, Parkinson's disease (PD)
Received
02 December 2025
Accepted
17 February 2026
Copyright
© 2026 Ibraheem, Vincentelli, Kuhnl, Kumar, Moya Davila, Patten, Yallop, Benjamin, Graham, Niblock and Sanderson. 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: Anas Ibraheem
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