Beyond Conventional Therapy: A Clinical Journey Through Fractionated Anti-CD19 CAR-T Cell Therapy in Relapsed / Refractory DLBCL
Abstract: Background: Diffuse Large B-Cell Lymphoma (DLBCL) is an aggressive B-cell malignancy that may relapse or become refractory despite conventional treatment. Chimeric Antigen Receptor T-cell (CAR-T) therapy represents an advanced cellular immunotherapy approach for selected patients with relapsed/refractory B-cell malignancies. Case Presentation: A 47-year-old male with relapsed/refractory DLBCL, Germinal Center B-cell (GCB) subtype, with a history of autologous hematopoietic stem cell transplantation and subsequent disease relapse, was admitted on 03/06/2026 for planned Anti-CD19 CAR-T cell therapy. The CAR-T product, Qartemi ? Varnimcabtagene Autoleucel, was administered using a fractionated dosing schedule. Intervention: Ten percent of the total CAR-T cell dose was administered on Day 0, followed by 30% on Day +3 and 60% on Day +7. The patient underwent daily neurological assessment and ICE scoring, daily CBC monitoring, and alternate-day CRP, LFT, RFT, and serum ferritin monitoring. Clinical Course: The patient tolerated all three CAR-T cell infusions without immediate infusion-related reactions. Throughout the monitoring period, he remained afebrile, hemodynamically stable, alert, oriented, and neurologically intact. No clinical features of Cytokine Release Syndrome (CRS) or Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) were observed, and ICE scores remained within normal limits. Outcome: No tocilizumab, corticosteroids, vasopressors, antibiotics, or intensive care interventions were required. The patient maintained adequate oral intake, hydration, mobility, and activities of daily living. He was discharged in stable condition on 15/06/2026 with post-CAR-T monitoring and infection-prevention instructions. Conclusion: This case highlights the importance of structured clinical surveillance, neurological assessment, laboratory monitoring, patient and family education, early recognition of CAR-T-related toxicities, and coordinated multidisciplinary nursing care during fractionated CAR-T cell therapy.
Keywords: DLBCL, Germinal Center B-cell subtype, CAR-T cell therapy, Anti-CD19, cellular therapy, CRS, ICANS, ICE score, nursing care
How to Cite?: Tirumala A, Carunia Jeyasutha, Dr. Rakesh Reddy Boya, "Beyond Conventional Therapy: A Clinical Journey Through Fractionated Anti-CD19 CAR-T Cell Therapy in Relapsed / Refractory DLBCL", Volume 15 Issue 9, September 2026, International Journal of Science and Research (IJSR), Pages: 1844-1847, https://www.ijsr.net/getabstract.php?paperid=SR26926124022, DOI: https://dx.doi.org/10.21275/SR26926124022