Case Report: Durable, well-tolerated complete response to epcoritamab plus pirtobrutinib in Richter transformation relapsing after CD19 CAR T-cell therapy.
- 1Hematology Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.
- 2Hematology Research Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
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.
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BibTeX
@article{barefah2026case,
title = {{Case Report: Durable, well-tolerated complete response to epcoritamab plus pirtobrutinib in Richter transformation relapsing after CD19 CAR T-cell therapy.}},
author = {Ahmed Salleh Barefah},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1998014},
url = {https://europepmc.org/article/MED/42908725},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Durable, well-tolerated complete response to epcoritamab plus pirtobrutinib in Richter transformation relapsing after CD19 CAR T-cell therapy.
AU - Ahmed Salleh Barefah
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1998014
UR - https://europepmc.org/article/MED/42908725
AB - 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.
SN - 2296-858X
ER -