As the population continues to age, the incidence of diffuse large B-cell lymphoma (DLBCL) among elderly patients is steadily increasing. Unfortunately, advanced age and multiple underlying health conditions often reduce both the effectiveness and tolerability of standard treatments—particularly in cases of relapsed or refractory (R/R) disease. For these high-risk patients, therapeutic options are limited and outcomes remain dismal. However, CAR-T cell therapy Carteyva offers a promising new avenue of hope for this vulnerable population.
Case Spotlight: A Patient Overcomes the Odds
A 70-year-old woman with a history of MALT lymphoma transformed to DLBCL relapsed just three months after achieving remission with Pola-R-CHP. Subsequent second- and third-line treatments, including GemOx and glofitamab, failed due to disease progression and complications like atrial fibrillation and infections.
With standard treatments exhausted, she received relmacabtagene autoleucel (relma-cel) CAR-T therapy. After bridging and lymphodepletion, CAR-T cells were infused in March 2025. PET-CT on Day 28 post-infusion showed complete remission (CR)—all lesions resolved and tumor markers normalized.
A Wider Challenge for R/R DLBCL
DLBCL accounts for 30–40% of non-Hodgkin lymphomas and is known for its aggressive nature. Around 25% of patients relapse or are refractory after first-line treatment. For elderly patients, the survival gap is even more striking:
- Patients <60 years: 3-year OS of 83.2%
- Patients >75 years: 3-year OS drops to 57.6%
Many elderly patients are ineligible for intensive treatments like ASCT. As a result, their prognosis remains extremely poor. In the SCHOLAR-1 study, the median overall survival for R/R DLBCL patients was just 6.3 months, with a CR rate of only 7%
The Promise of Carteyva (Relma-cel) CAR-T Therapy
Relma-cel is an autologous CAR-T therapy targeting CD19. It has shown high response rates with manageable safety risks, even in patients with high disease burden and poor performance status.
Key findings from the RELIANCE trial:
- ORR: 77.6%
- CR Rate: 53.5%
- ≥3 Grade CRS: 5.1%
- 4-year OS (CR patients): 82.5%
Importantly, these outcomes held strong even in patients over 65 and those with high IPI scores, confirming relma-cel’s value in real-world, high-risk settings.
Clinical Best Practices
To maximize success, relma-cel therapy should be guided by a multidisciplinary team (MDT). Key steps include:
- Early patient evaluation and treatment planning
- Careful bridging and personalized lymphodepletion
- Close monitoring of CRS and neurotoxicity post-infusion
- Consideration of combination strategies with other immunotherapies
Looking Ahead
This case reflects how relma-cel can dramatically improve outcomes for elderly, heavily pretreated R/R DLBCL patients. As real-world use expands and combination regimens evolve, CAR-T therapy like relma-cel is set to transform the treatment landscape for aggressive lymphomas once deemed untreatable.
