Successful treatment of refractory DLBCL coexisting with SLE using Liso-cel, complicated by cytokine release syndrome

Dear Editor, Lisocabtagene maraleucel (Liso-cel), a CD19-directed CAR-T therapy, is effective in relapsed or refractory high-grade B-cell lymphoma and has a low incidence of severe cytokine release syndrome (CRS) [1]. While recent studies have also demonstrated the efficacy of CD19 CAR-T therapies in autoimmune diseases such as SLE [2–4], no prior reports have documented the use of Liso-cel in patients with B-cell malignancies coexisting with SLE. We report a case of diffuse large B-cell lymphoma (DLBCL) coexisting with SLE, in which treatment with Liso-cel was successful despite the development of severe CRS. The patient was a woman in her 60s with a 30-year history of SLE. She tested positive on the Coombs test and was treated for pancytopenia and hypocomplementemia with prednisolone (5 mg/day), hydroxychloroquine (200 mg/day) and mycophenolate mofetil (1000 mg/day). She was also diagnosed with antiphospholipid syndrome, based on positive antiphospholipid antibody tests and a prior history of cerebral infarction. The patient was administered to have antiplatelet therapy. She demonstrated low disease activity, as assessed by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K).