{
  "abstract": "Richter transformation (RT) that relapses after CD19-directed chimeric antigen receptor (CAR) T-cell therapy has no established therapy and carries a dismal prognosis. We report an 84-year-old man with multiply relapsed, biopsy-proven diffuse large B-cell lymphoma-type RT and a high-risk MYC/BCL2 double-expressor phenotype who developed systemic relapse, with extensive osteolytic bone disease, after lisocabtagene maraleucel. Three cycles of atezolizumab produced no objective benefit. Treatment with epcoritamab, a CD3xCD20 bispecific antibody, plus pirtobrutinib, a non-covalent Bruton tyrosine kinase inhibitor, produced complete nodal metabolic resolution within 3 months that deepened to a complete metabolic response (Deauville score 2) by 10 treatment cycles, with resolution of two interim osteolytic lesions whose transient nature illustrates the interpretive challenges of PET/CT response assessment after cellular and T-cell-engaging therapies. The chemotherapy-free regimen was well tolerated at age 84, with no cytokine release syndrome, no neurotoxicity, and no cytopenias; the only toxicity was mild, reversible dexamethasone-related myopathy. The patient remains in ongoing clinical remission after approximately 10 months of therapy. This case extends the reported experience with epcoritamab plus pirtobrutinib specifically to the post-CAR T-cell relapse setting and suggests that this chemotherapy-free doublet may warrant consideration as a salvage strategy for older or frail patients with RT who are unfit for further cytotoxic therapy.",
  "abstract_shown": true,
  "affiliations": [
    "Hematology Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.",
    "Hematology Research Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Ahmed Salleh Barefah"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/145pjr9w1dtq4.bib",
  "cited_by": 0,
  "doi": "10.3389/fmed.2026.1998014",
  "fulltext_url": "https://europepmc.org/articles/PMC13683116",
  "id": "145pjr9w1dtq4",
  "issns": [
    "2296-858X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42908725",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2716|Chronic Lymphocytic Leukemia Research"
    ]
  ],
  "openalex": "W7220858563",
  "pdf_url": "https://europepmc.org/articles/PMC13683116?pdf=render",
  "pmcid": "PMC13683116",
  "pmid": "42908725",
  "published": "2026-10-07",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/145pjr9w1dtq4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42908725",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42908725"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2716|Chronic Lymphocytic Leukemia Research",
      "subfield": "human-genetics"
    }
  ],
  "title": "Case Report: Durable, well-tolerated complete response to epcoritamab plus pirtobrutinib in Richter transformation relapsing after CD19 CAR T-cell therapy.",
  "title_text": "Case Report: Durable, well-tolerated complete response to epcoritamab plus pirtobrutinib in Richter transformation relapsing after CD19 CAR T-cell therapy.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:57Z",
  "url": "https://research.draconitic.com/paper/145pjr9w1dtq4",
  "venue": "Frontiers in medicine",
  "versions": []
}