[Prolonged cytopenia following third-line CAR-T therapy in a heavily chemotherapy-pretreated patient.]

A 28-year-old woman was diagnosed with high-risk triple-expressor diffuse large B-cell lymphoma (DLBCL) (stage IV, IPI 4, CNS-IPI 5), with lymph node and extranodal involvement. The patient underwent first-line R-CHOP treatment, achieving a partial response with residual mediastinal uptake. A second-line platinum-based therapy with a transplant plan followed, resulting in stable disease; thus, she was considered refractory and started third-line therapy with CAR-T cells, receiving additional chemotherapy as bridging therapy. CAR-T treatment was well tolerated but complicated by late, persistent grade 4 cytopenia for over 2 years post-treatment, with complete and lasting lymphoma remission. Repeated chemotherapy exposure may predispose to acute and chronic toxicities, including cytopenia after CAR-T. If evaluated in 2024, the patient would have been considered for early access to CAR-T therapy, potentially reducing toxicity risks and improving event-free survival compared to conventional therapy.