CAR-T therapy demonstrated safety and efficacy in relapsed/refractory diffuse large B-cell lymphoma patients complicated with hepatitis B related cirrhosis

Abstract Chimeric antigen receptor T cell (CAR-T) therapy has demonstrated both efficacy and safety in relapsed/refractory diffuse large B-cell lymphoma (DLBCL) patients infected with hepatitis B virus (HBV). However, its applicability in individuals with liver cirrhosis remains largely unexplored due to the potential for unpredictable complications. Here, we report three cases (P1, P2, P3) of relapsed/refractory DLBCL with HBV-related cirrhosis treated with CAR-T cells infusion. P1 and P2 received CAR-T cells infusion following a conditioning regimen of fludarabine and cyclophosphamide (FC) for lymphodepletion; while P3 received SEAM (CCNU, etoposide, cytarabine, and melphalan) regimen and autologous stem cell transplantation bridging CAR-T cells infusion. P1 and P2 achieved rapid complete remission (CR), whereas P3 initially exhibited stable disease a month post-CAR-T infusion and subsequently achieved CR after local radiation salvage therapy and lenalidomide maintenance. With a median follow-up of 42 months after CAR-T, the progression free survival rate was 100%. Notably, during follow-up, these patients experienced complications associated with cirrhosis, including endoscopic variceal bleeding, HBV reactivation, or the diagnosis of hepatic malignancy. Our findings suggest that CAR-T therapy is highly effective for the treatment of DLBCL patients with HBV-related cirrhosis, albeit necessitating monitoring for potential hepatic complications.