A 60-Year-Old Man With Primary Refractory Large B-Cell Lymphoma

This case centers on a 60-year-old man with primary refractory diffuse large B-cell lymphoma (DLBCL), a condition that presents significant therapeutic challenges. Despite receiving standard frontline treatment with curative intent—6 cycles of R-CHOP—the patient experienced early disease progression within 7 months. This pattern indicates chemo-refractory disease, which carries a poor prognosis and suggests that the initial therapy failed to eliminate residual lymphoma cells. Early relapse following frontline treatment necessitates a reevaluation of therapeutic goals and a shift in strategy.

Given the timing and nature of the relapse, this case underscores the urgency of considering more aggressive or novel approaches, such as referral to a transplant and cellular therapy center for chimeric antigen receptor (CAR) T-cell therapy. CAR T is increasingly becoming a standard option for patients with primary refractory DLBCL, especially those who progress within 12 months of frontline therapy. In this scenario, the patient was a candidate for further intervention due to his relatively good performance status and manageable disease burden. His ability to tolerate initial therapy supports consideration for intensive treatment moving forward.

Effective management of such a case also involves thorough communication with the patient regarding prognosis and expectations. While curative therapy may still be possible, clinicians must clearly outline the differences between the initial treatment setting and the current relapse scenario. Balancing hope with realistic outcomes is essential. Additionally, this case highlights the importance of timely referral and interdisciplinary coordination in delivering potentially lifesaving therapies like CAR T, which may offer durable responses in otherwise high-risk lymphoma cases.