One Patient Diagnosed With Primary Refractory Diffuse Large B Cell Lymphoma Successfully Salvaged With BCL2 Inhibitor Followed by anti-CD19 CAR-T Suffered From a Secondary Onset of Severely CRS

Background: Treatment of relapsed/refractory diffuse large B cell lymphoma (DLBCL) eligible for transplantation is limited by the efficacy of salvage therapy. Chimeric antigen receptor modified T cell (CAR-T) therapy has achieved the highest response rate of salvage therapy for relapsed/refractory aggressive B cell lymphoma. Cytokine release syndrome (CRS) and cytopenia are main side effects of CAR-T therapy. Case presentation A 61 years old Chinese male diagnosed as DLBCL was treated with rituximab combined with chemotherapy, unfortunately, he was resistant to first-line chemotherapy and other regimens. Due to high expression of BCL2 protein and amplification of BCL2 by next sequence generation, BCL2 inhibitor combined with low intensity chemotherapy was given to him as a bridge to anti-19 CAR-T therapy. Although escalation of dose from 100mg per day to 400mg in one week, he had no tumor lysis syndrome and achieved partial response. He suffered persist pancytopenia after CAR T-cells infusion, moreover, a severely secondary CRS on 54th day was observed and responded well to steroid. Discussion: and conclusions BCL2 inhibitor may have a role in frontline or salvage therapy of DLBCL, especially for those with high BCL2 protein expression, mechanism of which should be still investigated. CAR-T therapy revolutionized the salvage of primary refractory DLBCL, but we should focus on persist cytopenia and severe CRS, and we reported the latest secondary CRS till now.