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Case Report
The effective and safe administration of Epcoritamab in relapsed CD19-CD5+ DLBCL following CAR-T therapy
Takashi Shimakawa1,2, Noriaki Kawano1, Yuichiro Semba2, Yasuo Mori2, Ken Takigawa2, Takuji Yamauchi2, Kohta Miyawaki2, Fumiaki Jinnouchi2, Teppei Sakoda2, Kyohei Mori2, Masatoshi Shimo2, Masahiro Otsu2, Riichiro Ikeda2, Shunya Shiraishi1, Takashi Nakaike1, Kiyoshi Yamashita1, Koichi Mashiba1, Ikuo Kikuchi1, Kousuke Marutsuka3, Koichi Ohshima4, Sawako Matsuzaki5, Kennosuke Karube6, Koji Kato2, Takahiro Maeda2, Koichi Akashi2

1Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan

2Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Science, Fukuoka, Japan

3Department of Pathology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan

4Department of Pathology, Kurume University, Fukuoka, Japan

5Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan

6Department of Pathology and Laboratory Medicine, Nagoya University, Aichi, Japan

Keywords
relapse after CAR-T therapy, CD19 negative relapsed DLBCL, MCD type with multiple genetic mutations, epcoritamab, debulking therapy
Submitted: December 23, 2024
Accepted: April 18, 2025
Published online: August 1, 2025

Abstract

Background: Chimeric antigen receptor T-cell (CAR-T) therapy has transformed the treatment landscape for relapsed or refractory non-Hodgkin lymphoma, achieving a 5-year overall survival rate of 40-50%. However, relapse remains a major challenge, especially due to CD19-negative clones. Epcoritamab, a bispecific antibody targeting CD20 and CD3, offers a potential solution for post-CAR-T relapse; however, clinical data in this setting remain limited, particularly in Japan.

The case: A 68-year-old woman with CD5-positive diffuse large B-cell lymphoma (DLBCL) relapsed multiple times following various treatments, including CAR-T therapy. Genetic profiling revealed a MYD88/CD79B-mutated (MCD) subtype with CD19-negative clones resistant to CAR-T cells. Given her high tumor burden, she received debulking therapy followed by epcoritamab treatment. Despite concerns about tumor lysis syndrome, cytokine release syndrome, and neurotoxicity, no significant adverse events occurred. The patient achieved a complete remission, demonstrating the efficacy and safety of this approach.

Conclusion: This case highlights the potential of epcoritamab combined with debulking therapy for treating CAR-T-refractory CD19-negative DLBCL. This is the first validated case in Japan showing that epcoritamab is a viable and safe treatment option for post-CAR-T relapse, addressing a critical unmet need in the current therapeutic landscape.

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Online ISSN:2432-7026