Case Report: Glofitamab and intrathecal rituximab combined with ICE chemotherapy for early isolated central nervous system relapse in pediatric Burkitt lymphoma: rapid clearance and successful bridging to autologous stem cell transplantation

Background Central nervous system (CNS) relapse is an uncommon and highly aggressive event in pediatric Burkitt lymphoma (BL), particularly when occurring early with parenchymal involvement. Despite CNS-directed chemotherapy, rapid and durable disease control remains challenging. Glofitamab, a CD20×CD3 bispecific T-cell engager, has shown activity in relapsed/refractory B-cell lymphomas, but its role in pediatric BL with CNS relapse remains unexplored. Intrathecal rituximab provides direct CNS delivery of anti-CD20 antibody. We treated a child with early isolated CNS relapse of BL using systemic glofitamab combined with intrathecal rituximab. Case presentation An 11-year-old boy with stage IV, R4-group BL involving bone marrow and CNS achieved complete remission after frontline CCCG-BNHL-2015 therapy. Three months after treatment cessation, he developed headache, vomiting, and blurred vision. Brain MRI showed multiple parenchymal CNS lesions, while bone marrow and thoracoabdominal imaging revealed no systemic relapse. CSF flow cytometry showed an abnormal B-cell population comprising 44.63% of nucleated cells, confirming early isolated CNS relapse. The patient received three cycles of ICE chemotherapy combined with glofitamab, along with seven administrations of intrathecal rituximab and four administrations of triple intrathecal chemotherapy. Glofitamab was administered with obinutuzumab pretreatment and step-up dosing, while intrathecal rituximab was combined with methotrexate, cytarabine, and dexamethasone. Neurological symptoms improved rapidly, and CSF abnormal B cells decreased from 44.63% to undetectable levels within 10 days. He subsequently underwent CNS-directed radiotherapy and autologous hematopoietic stem cell transplantation. Serial CSF flow cytometry remained negative, and follow-up brain MRI showed no active disease. The patient remains in continuous complete remission. Conclusion Systemic glofitamab combined with intrathecal rituximab may represent a feasible compartment-adapted strategy for early isolated CNS relapse of pediatric BL. Although the individual contributions of the treatment components cannot be determined because of concomitant therapies, rapid CSF clearance within 10 days enabled subsequent consolidation with autologous hematopoietic stem cell transplantation. To our knowledge, this is the first reported use of this combination in pediatric BL with isolated CNS relapse, supporting further investigation of bispecific antibody-based immunotherapy combined with CNS-directed therapy.