A patient with POD24 follicular lymphoma (FL) achieved a complete remission (CR) lasting more than seven months after treatment with relme-cel (Carteyva), a CD19-directed CAR-T cell therapy approved in China for relapsed or refractory follicular lymphoma.
The case demonstrates the potential of CAR-T therapy to overcome one of the most challenging forms of follicular lymphoma—patients whose disease progresses within 24 months of first-line treatment.
Why POD24 Matters
Follicular lymphoma is generally considered an indolent B-cell non-Hodgkin lymphoma, but approximately 15–20% of patients experience disease progression within 24 months (POD24) after initial immunochemotherapy.
Patients with POD24 typically have:
- More aggressive disease biology
- Limited benefit from conventional salvage therapy
- Significantly worse long-term survival
- A five-year overall survival rate of approximately 50%
Because of these poor outcomes, more effective treatment strategies are urgently needed.
Patient Profile
- Age: 52 years
- Sex: Male
- Diagnosis: Grade 3A Follicular Lymphoma, Stage IV
- FLIPI Score: 3 (high-risk)
Medical History
The patient presented in April 2025 with persistent buttock pain. CT imaging revealed a massive retroperitoneal tumor along with multiple enlarged lymph nodes.
A biopsy confirmed B-cell non-Hodgkin lymphoma consistent with follicular lymphoma, with approximately 95% low-grade disease and a small Grade 3A component.
Additional findings included:
- Extensive retroperitoneal disease
- Multiple lymph node regions involved
- Suspicious splenic lesions
- Possible tumor thrombus involving the inferior vena cava and iliac veins
Bone marrow examination showed no lymphoma involvement.
First-Line Treatment
The patient initially received:
- 1 cycle of R-CDOP
- 3 cycles of R-CHOP
Although lymph nodes initially shrank, PET-CT after four cycles demonstrated progressive disease (PD).
The patient therefore met the criteria for POD24, indicating early treatment failure and a poor prognosis.
Transition to CAR-T Therapy
Given the rapid progression and preserved organ function, the multidisciplinary team proceeded with CAR-T therapy.
Treatment Timeline
July 25, 2025
- Leukapheresis performed for CAR-T manufacturing.
Bridge Therapy
- Pirtobrutinib
- R-GemOx (Rituximab, Gemcitabine, Oxaliplatin)
This helped reduce tumor burden before infusion.
September 2025
- Fludarabine/Cyclophosphamide (FC) lymphodepletion
- Relma-cel CAR-T infusion on September 15
Safety
Following infusion, the patient experienced manageable adverse events:
- Grade 2 cytokine release syndrome (CRS)
- Grade 2 neutropenia
- Grade 1 thrombocytopenia
- Herpes zoster infection
All complications resolved with supportive care.
Importantly, no severe neurotoxicity occurred.
Outstanding Response
Just 30 days after CAR-T infusion, PET-CT demonstrated:
- Complete disappearance of the large retroperitoneal mass
- Complete metabolic remission (CR)
Follow-up PET-CT in April 2026 confirmed the patient remained in complete remission.
As of May 2026, the patient had maintained CR for more than seven months while enjoying a good quality of life.
Why This Case Is Important
This case illustrates that Relma-cel can induce deep and durable remission even in patients with:
- POD24 disease
- High tumor burden
- Bulky retroperitoneal lymphoma
- Advanced Stage IV disease
Early referral for CAR-T evaluation may therefore be particularly valuable for patients whose disease progresses soon after first-line therapy.
Clinical Evidence Supporting Relma-cel
Relma-cel is China’s first approved CD19-directed CAR-T therapy for relapsed or refractory follicular lymphoma.
Its CAR construct combines:
- A 4-1BB co-stimulatory domain, promoting long-term CAR-T persistence
- A CD28-derived hinge and transmembrane region, designed to improve antigen recognition and cytotoxic activity
RELIANCE Study Results
More than half (53.6%) of patients enrolled in the pivotal RELIANCE trial had POD24 disease.
After two years of follow-up, investigators reported:
| Outcome | Result |
|---|---|
| Best Overall Response Rate (ORR) | 100% |
| Complete Response (CR) | 96.3% |
| 2-year Progression-Free Survival | 80.3% |
| 2-year Overall Survival | 100% |
| Median PFS | Not reached |
| Median OS | Not reached |
Safety
The therapy also demonstrated a favorable safety profile:
- No Grade 3 or higher CRS
- Only one patient experienced Grade 3 or higher neurotoxicity
- No treatment-related deaths
CAR-T Shows Strong Activity in POD24 Patients
A recent meta-analysis evaluating CD19 CAR-T therapy specifically in POD24 follicular lymphoma reported:
- Overall Response Rate: 91.2%
- Complete Response Rate: 75.7%
These findings further support CAR-T therapy as one of the most promising treatment options for this difficult-to-treat patient population.
Looking Ahead
As additional real-world evidence becomes available, researchers hope to better define:
- The optimal timing for CAR-T therapy
- The most effective bridging strategies
- Long-term disease monitoring after treatment
This case adds to the growing evidence that early use of CAR-T therapy may significantly improve outcomes for patients with POD24 follicular lymphoma, particularly those with bulky or rapidly progressive disease.
