# Successful Use of Chimeric Antigen Receptor T-cell (CAR-T) Therapy With Lisocabtagene Maraleucel in a Renal Transplant Recipient With Refractory/Relapsed Diffuse Large B-Cell Lymphoma (DLBCL)

## TL;DR

A kidney transplant recipient successfully received CAR-T therapy for a hard-to-treat lymphoma, showing the treatment's potential in post-transplant patients.

## Contribution

Demonstrates successful CAR-T therapy in a renal transplant patient with refractory DLBCL, highlighting immunosuppressive management strategies.

## Key findings

- CAR-T therapy with lisocabtagene maraleucel was effective in a post-transplant lymphoma patient.
- No significant toxicities like CRS or ICANS were observed after treatment.
- Balanced immunosuppression was maintained to protect the graft while allowing treatment.

## Abstract

This case describes a 53-year-old male with end-stage renal disease who developed monomorphic post-transplant lymphoproliferative disorder (PTLD) in the form of diffuse large B-cell lymphoma (DLBCL) after kidney transplantation. Despite initial treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP), the patient’s disease progressed, and he was referred for chimeric antigen receptor (CAR) T-cell therapy with lisocabtagene maraleucel (liso-cel). Given his post-transplant status, his immunosuppressive agents (tacrolimus and mycophenolate) were held, and prednisone was tapered to 5 mg daily to maintain minimal baseline immunosuppression. After lymphodepleting chemotherapy and liso-cel infusion, the patient experienced no significant toxicities, including cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS). This case underscores the potential of CAR-T therapy for refractory/relapsed DLBCL in post-transplant patients, emphasizing the need for careful immunosuppressive management to balance graft protection and treatment efficacy.