Liposomal Vincristine As A Bridge Therapy Prior To Car-T Therapy in Relapsed and Refractory Diffuse Large B-Cell Lymphoma?

We report a case of a 76-year-old male with a history of relapsed and refractory diffuse large b-cell lymphoma (dlbcl).our patient was initially treated with front line chemotherapy along with central nervous system (cns) prophylaxis with complete response. he subsequently relapsed, was sensitive to second-line chemotherapy, and underwent autologous stem cell transplantation achieving a complete remission. only a few months after transplant, the patient suffered his second relapse and was deemed a candidate for chimeric antigen receptor t-cell therapy (car- t). given his aggressive disease, combined with the time needed to generate car-t cells, a multidisciplinary team recommended to treat our patient with liposomal vincristine in combination with rituximab as a bridge therapy. durable responses have been seen using liposomal vincristine based on results from a recent phase ii trial in heavily pretreated patients with dlbcl^1. this therapy was effective in stabilizing and reducing active disease in our patient. this case looks to illustrate the use of liposomal vincristine in combination with immunotherapy in a novel setting bridging highly selected patients with active and refractory lymphoma prior to car-t. moreover, we expanded an additional therapeutic point, highlighting the importance of optimal disease control prior to car-t cell harvesting, as recent literature has shown that residual malignant cells in the pheresis product may be inadvertently be transfected with the car gene, resulting in resistance and further relapse^2.