DURABLE PARTIAL RESPONSE TO EPCORITAMAB IN A MULTIPLY RELAPSED/REFRACTORY ELDERLY PATIENT WITH DIFFUSE LARGE B-CELL LYMPHOMA: A CASE REPORT
- 1Hospital Santa Izabel/Oncoclínicas, Santa Casa da Bahia, Salvador, BA, Brazil
Abstract
Background: Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma, with elevated first-line cure rates. The main clinical challenge lies beyond first-line therapy, particularly in primary refractory disease, which tends to respond poorly to further cytotoxic chemotherapy and autologous stem cell transplantation. Chemotherapy-free targeted therapies have emerged as a promising alternative for chemorefractory patients, aiming to shift this therapeutic paradigm. Real-world experience describing durable responses with epcoritamab remains scarce. Case report: A 69-year-old woman was diagnosed with germinal-center-type DLBCL, stage IIIXB (bulky retroperitoneal mass), IPI 3 (high-intermediate risk), poor-risk R-IPI, and a Ki-67 index of 90%. She received six cycles of R-CHOP as first-line therapy; restaging PET-CT 30 days later showed a Deauville score of 3 (partial response). Less than three months after treatment completion, she developed clinical evidence of progression, and second-line R-GDP was started. PET-CT after the first cycle confirmed refractory disease, with an enlarging retroperitoneal conglomerate, new lymphadenopathy, and hydronephrosis. Third-line therapy with tafasitamab plus lenalidomide was started; following the second cycle, she was admitted with further enlargement of the retroperitoneal conglomerate and extensive venous thrombosis. During hospitalization, she developed a severe motor deficit; spinal MRI revealed neoplastic infiltration of L2–L3 with pathological fracture and an epidural component compressing the thecal sac and narrowing the spinal canal. Palliative radiotherapy was initiated but discontinued owing to poor clinical response. The patient began her fourth pharmacological line with epcoritamab. During the first cycle, she developed grade 2 cytokine release syndrome (CRS), managed with tocilizumab, and grade 2 immune effector cell-associated neurotoxicity syndrome (ICANS), managed with dexamethasone. Neurological recovery was achieved, and she was discharged after a prolonged hospitalization complicated by infection, including a psoas infectious collection. Control PET-CT, performed four months after treatment initiation, showed a partial metabolic response (Deauville score 4), with a marked reduction in SUV of the retroperitoneal conglomerate. On ambulatory follow-up, a subsequent PET-CT after cycle 10 of monthly-maintenance epcoritamab again showed a sustained partial response (Deauville score 4), this time with volumetric reduction of the retroperitoneal mass. At her most recent visit, 16 months after treatment initiation, the patient remained on monthly epcoritamab maintenance. Urinary tract ultrasound showed resolution of hydronephrosis. Treatment was well tolerated, with no further infectious complications since the initial CRS/ICANS-related hospitalization and no evidence of hypogammaglobulinemia (IgG maintained >500 mg/dL). Functionally, the patient retained a severe motor deficit related to spinal cord compression and continued to require wheelchair support, with progressive improvement on motor physiotherapy. Conclusion: We report the case of an elderly, multiply refractory DLBCL patient who achieved a sustained partial metabolic response with epcoritamab beyond 12 months, illustrating that durable disease control, even short of complete response, may represent a clinically meaningful outcome.
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BibTeX
@article{junior2026durable,
title = {{DURABLE PARTIAL RESPONSE TO EPCORITAMAB IN A MULTIPLY RELAPSED/REFRACTORY ELDERLY PATIENT WITH DIFFUSE LARGE B-CELL LYMPHOMA: A CASE REPORT}},
author = {Valney Oliveira SANTOS JUNIOR and Nelma Carneiro DE ARAUJO and Maura Alice Santos ROMEO and Beatriz Moura PORTUGAL and Giulia Beatriz Correia MATOS and Lorhane Nunes DOS ANJOS},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.107756},
url = {https://doi.org/10.1016/j.htct.2026.107756},
note = {CC BY},
}
RIS
TY - JOUR
TI - DURABLE PARTIAL RESPONSE TO EPCORITAMAB IN A MULTIPLY RELAPSED/REFRACTORY ELDERLY PATIENT WITH DIFFUSE LARGE B-CELL LYMPHOMA: A CASE REPORT
AU - Valney Oliveira SANTOS JUNIOR
AU - Nelma Carneiro DE ARAUJO
AU - Maura Alice Santos ROMEO
AU - Beatriz Moura PORTUGAL
AU - Giulia Beatriz Correia MATOS
AU - Lorhane Nunes DOS ANJOS
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.107756
UR - https://doi.org/10.1016/j.htct.2026.107756
AB - Background: Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma, with elevated first-line cure rates. The main clinical challenge lies beyond first-line therapy, particularly in primary refractory disease, which tends to respond poorly to further cytotoxic chemotherapy and autologous stem cell transplantation. Chemotherapy-free targeted therapies have emerged as a promising alternative for chemorefractory patients, aiming to shift this therapeutic paradigm. Real-world experience describing durable responses with epcoritamab remains scarce. Case report: A 69-year-old woman was diagnosed with germinal-center-type DLBCL, stage IIIXB (bulky retroperitoneal mass), IPI 3 (high-intermediate risk), poor-risk R-IPI, and a Ki-67 index of 90%. She received six cycles of R-CHOP as first-line therapy; restaging PET-CT 30 days later showed a Deauville score of 3 (partial response). Less than three months after treatment completion, she developed clinical evidence of progression, and second-line R-GDP was started. PET-CT after the first cycle confirmed refractory disease, with an enlarging retroperitoneal conglomerate, new lymphadenopathy, and hydronephrosis. Third-line therapy with tafasitamab plus lenalidomide was started; following the second cycle, she was admitted with further enlargement of the retroperitoneal conglomerate and extensive venous thrombosis. During hospitalization, she developed a severe motor deficit; spinal MRI revealed neoplastic infiltration of L2–L3 with pathological fracture and an epidural component compressing the thecal sac and narrowing the spinal canal. Palliative radiotherapy was initiated but discontinued owing to poor clinical response. The patient began her fourth pharmacological line with epcoritamab. During the first cycle, she developed grade 2 cytokine release syndrome (CRS), managed with tocilizumab, and grade 2 immune effector cell-associated neurotoxicity syndrome (ICANS), managed with dexamethasone. Neurological recovery was achieved, and she was discharged after a prolonged hospitalization complicated by infection, including a psoas infectious collection. Control PET-CT, performed four months after treatment initiation, showed a partial metabolic response (Deauville score 4), with a marked reduction in SUV of the retroperitoneal conglomerate. On ambulatory follow-up, a subsequent PET-CT after cycle 10 of monthly-maintenance epcoritamab again showed a sustained partial response (Deauville score 4), this time with volumetric reduction of the retroperitoneal mass. At her most recent visit, 16 months after treatment initiation, the patient remained on monthly epcoritamab maintenance. Urinary tract ultrasound showed resolution of hydronephrosis. Treatment was well tolerated, with no further infectious complications since the initial CRS/ICANS-related hospitalization and no evidence of hypogammaglobulinemia (IgG maintained >500 mg/dL). Functionally, the patient retained a severe motor deficit related to spinal cord compression and continued to require wheelchair support, with progressive improvement on motor physiotherapy. Conclusion: We report the case of an elderly, multiply refractory DLBCL patient who achieved a sustained partial metabolic response with epcoritamab beyond 12 months, illustrating that durable disease control, even short of complete response, may represent a clinically meaningful outcome.
SN - 2531-1379
SN - 2531-1387
ER -