Relapsed Diffuse Large B-Cell Lymphoma: A 41-Year-Old Achieves Complete Remission After CAR-T Therapy

Summary: Li Xiang (pseudonym), 41, was diagnosed with diffuse large B-cell lymphoma (DLBCL) after developing a persistent dry cough and night sweats. He initially achieved complete remission after systemic chemotherapy and local radiotherapy, but new hypermetabolic lesions were found just over six months after treatment ended, indicating an early relapse. After transferring to Beijing GoBroad Hospital, Dr. Kai Hu and his team assessed his overall condition, tumor burden, target expression, and the absence of central nervous system involvement, and developed an individualized treatment plan consisting of bridging therapy followed by CD19 CAR-T cell therapy. After infusion, he developed Grade 1 cytokine release syndrome (CRS), which resolved with timely management, and he experienced no immune effector cell-associated neurotoxicity syndrome (ICANS). One month after CAR-T therapy, he achieved a partial response. He then received maintenance therapy, and approximately three months after infusion, the lesions had completely disappeared, indicating complete remission. He has since returned to his normal daily life and continues regular follow-up. His experience illustrates the full treatment journey for early-relapsed DLBCL, from reassessment and bridging therapy to CAR-T infusion and deepening response, and highlights the importance of comprehensive care throughout cell therapy.

If the first lymphoma diagnosis felt like a storm that came without warning, for 41-year-old Li Xiang, having the disease return only six months after complete remission was an even greater test.

It all began in August 2024 with what seemed like an ordinary irritating dry cough. What followed was a prolonged battle between his immune system and lymphoma.

A Long Road to a Clear Diagnosis

At first, Li Xiang simply felt tired, with night sweats and a dry cough that worsened at night. At a hospital outside his home region, a mediastinal needle biopsy performed during bronchoscopy produced an inconclusive result: “reactive hyperplasia of fragmented lymphoid tissue.” Oral steroid treatment did not improve his condition, and the enlarged lymph nodes persisted.

After seeking care at several hospitals, an outside pathology review finally provided a clearer diagnosis: a lymphoproliferative lesion consistent with B-cell lymphoma, possibly nodal marginal zone lymphoma with transformation toward large B-cell lymphoma, or Grade 3A follicular lymphoma. Genetic testing identified a CD79B mutation, and PET-CT showed a Deauville score of 5. Li Xiang was ultimately diagnosed with diffuse large B-cell lymphoma (DLBCL), non-GCB subtype, Stage IVB, with an IPI score of 2 and an ECOG performance status of 1.

He then received six cycles of R2-CHOP together with local mediastinal radiotherapy. At the end of treatment, PET-CT showed complete disappearance of the lesions and a Deauville score of 1, confirming complete remission.

But the remission lasted only six months.

Relapse: What Comes Next?

In January 2026, just over six months after completing treatment, ultrasound detected abnormal lymph nodes in the left supraclavicular and axillary regions. A subsequent PET-CT confirmed a new hypermetabolic retroperitoneal lesion, and the Deauville score had returned to 5. The lymphoma had relapsed.

Li Xiang and his family did not give in to panic. They began researching the latest lymphoma treatments in China and abroad, and through both their own research and recommendations from other patients, one name came up repeatedly: Dr. Kai Hu, Director of the Department of Lymphoma and Myeloma at Beijing GoBroad Hospital.

Dr. Hu and his team were among the earlier groups in China to systematically incorporate CAR-T cell therapy into clinical practice and have accumulated extensive experience in individualized treatment for relapsed or refractory lymphoma.

Li Xiang's family brought his complete medical records to Dr. Hu. After carefully reviewing his diagnosis and treatment history, Dr. Hu identified several key points: although the disease had relapsed, Li Xiang remained in relatively good overall condition and his tumor burden was still manageable; biopsy after relapse showed high expression of CD19, CD20, CD22, and CD79b; and there was no central nervous system involvement.

Taken together, these features made CAR-T therapy a particularly suitable treatment option.

During detailed discussions with the family, Dr. Hu explained who may benefit from CAR-T therapy, its potential risks and benefits, and the careful management required at each stage of treatment. After fully understanding the treatment plan, the family chose ranicabtagene autoleucel (HICARA®), a CD19-directed CAR-T therapy approved in China.

Bridging, Lymphodepletion, and Infusion: Each Step Matters

Once the decision to proceed with CAR-T therapy was made, Dr. Hu's team first used cytoreductive treatment to bring the disease burden down. In February 2026, Li Xiang received a second-line regimen centered on POLA plus platinum-based chemotherapy, together with targeted therapy. This “bridging therapy” was intended to reduce tumor burden as much as possible before CAR-T infusion and create a more favorable setting for the infused immune cells to work.

On March 6, 2026, Li Xiang began FC lymphodepleting conditioning. On March 11, ranicabtagene autoleucel was infused.

On Day 4 after infusion, Li Xiang developed recurrent high fever and headache. The team promptly assessed this as Grade 1 cytokine release syndrome (CRS). He had no hypotension or hypoxemia, his ICE score was 10, and there were no signs of ICANS.

Following the team's pre-established, risk-stratified management plan, an IL-6 antagonist was administered promptly to control the immune reaction. His temperature gradually normalized, and the CAR-T cells expanded well in his body. He did not develop higher-grade CRS or ICANS at any point.

After the Initial Response: Moving into Maintenance Therapy

About one month after CAR-T infusion, Li Xiang underwent his first response assessment. PET-CT showed a marked decrease in metabolic activity in both the original and newly developed lesions, with the Deauville score falling to 3. He had achieved a partial response.

The result gave both the care team and the family renewed confidence. After evaluation, Dr. Hu's team believed the response could deepen further as the CAR-T cells continued to exert their effect.

Li Xiang then moved into maintenance treatment. Under the plan developed by Dr. Hu's team, he received lenalidomide plus a BTK inhibitor to consolidate the response to CAR-T therapy and reduce the longer-term risk of relapse.

In June 2026, approximately three months after infusion, Li Xiang underwent another PET-CT. This time, the lesions had completely disappeared and the Deauville score had fallen to 1 — confirming complete remission.

From a Deauville score of 5 at relapse to a score of 1 three months after CAR-T therapy, Li Xiang had made remarkable progress in just three months.

Today, Li Xiang is back to his normal life. He exercises moderately, follows a regular diet, and returns to the hospital for scheduled follow-up. “After going through this twice, I understand the value of good health more than ever,” he said. “I am grateful to Dr. Hu and his team, and to my family for always being there for me.”

Dr. Kai Hu said: “Li Xiang's treatment course again demonstrates the value of CAR-T cell therapy in relapsed or refractory diffuse large B-cell lymphoma. For patients with early relapse, high target expression, and no central nervous system involvement, CAR-T therapy can be an important potentially curative option. CAR-T therapy is not the end of treatment, however. Maintenance therapy and long-term follow-up remain equally important.”