A 67-Year-Old Woman With 3L R/R Large B-Cell Lymphoma

This case presents a realistic example of the complexities encountered when managing R/R LBCL. Initially eligible for CAR T-cell therapy in the second-line setting, this patient was unable to proceed due to personal responsibilities. Despite achieving a complete response with second-line treatment, her disease progressed again, highlighting the need for durable therapeutic strategies. Now in the third-line setting, with barriers removed, she remains a strong candidate for CAR T-cell therapy. The absence of disqualifying comorbidities, persistent CD19 positivity, and her readiness to meet logistical requirements reinforce this as the preferred treatment choice.

The evolution of treatment options in this space has been significant. Prior to the introduction of CAR T-cell therapies, third-line management often relied on salvage chemoimmunotherapy regimens, offering limited durability and few curative outcomes. Autologous stem cell transplant was a standard option for eligible patients but excluded many due to age, comorbidities, or treatment resistance. With CAR T-cell therapy now approved and incorporated into NCCN guidelines for both early and later relapses, it has dramatically shifted treatment goals from palliation to potential cure, even in heavily pretreated patients.

Looking forward, this shift marks a broader change in treatment philosophy for aggressive lymphomas. The third-line setting, once considered a terminal phase with limited options, now holds curative promise thanks to cellular therapies. While clinical infrastructure and access challenges remain, especially for older or underserved populations, expanding CAR T availability and earlier referral may continue to improve outcomes. Cases such as this one emphasize the importance of timing, eligibility reassessment, and patient-centered care planning to maximize long-term remission and survival.