Successful Treatment of a Relapsed, Refractory Diffuse Large B-Cell Lymphoma (R/R DLBCL) Patient and Newly Diagnosed Meningeosis Lymphomatosa with CD19 CAR-T Cell Therapy and Intrathecal Chemotherapy: A Case Report

CD19 chimeric antigen receptor-modified (CAR)-T cell therapy can achieve similar response rates in Secondary central nervous system lymphoma (SCNSL) as in patients without central nervous system (CNS) involvement. However, the therapeutic success differs significantly when a distinction is made between parenchymal and meningeal involvement. A 42-year-old female patient with r/r DLBCL was treated with CD19 CAR-T cell therapy. The patient was diagnosed with meningeosis lymphomatosa six days after the administration of the CAR-T cells. The lumbar puncture was performed because of severe therapy refractory headaches. We additionally administered intrathecal chemotherapy after reaching a Partial Remission (PR) with CAR T cells with Methotrexate, Cytarabine and Dexamethasone. At the time of the report the patient has been in Complete Remission (CR) in the CNS and regarding the peripheral DLBCL manifestations for two months. To the authors' knowledge, this patient's case is the first case in which intrathecal chemotherapy was used in addition to CAR-T cells to treat clinically progressive meningeosis first diagnosed under CAR-T cell therapy. The follow-up progress so far appears promising, but the long-term course remains to be seen.