病例报告：一线 CD19 CAR-T 细胞疗法联合靶向方案在新诊断继发性中枢神经系统淋巴瘤中诱导持久完全缓解：两例报告

Secondary central nervous system lymphoma (SCNSL) at initial diagnosis is an aggressive malignancy associated with a dismal prognosis. Standard-of-care treatments based on high-dose methotrexate often yield suboptimal outcomes. Although CD19-directed chimeric antigen receptor T-cell (CD19 CAR-T-cell) therapy is established in relapsed/refractory settings, its efficacy as a frontline intervention for SCNSL remains poorly defined.

We report two cases of treatment-naive SCNSL that achieved sustained complete remission (CR) following a novel sequential therapeutic approach. Case 1 (65-year-old male) received Pola-ZR induction therapy (polatuzumab vedotin, zanubrutinib, and rituximab), while Case 2 (56-year-old female) received ZPR induction therapy (zanubrutinib, pomalidomide, and rituximab) followed by autologous stem cell transplantation.

Both patients subsequently received CD19 CAR-T-cell infusions. Rapid CR was achieved and maintained for 24 and 21 months, respectively, with manageable toxicities. Frontline CAR-T-cell therapy combined with targeted agents may constitute a promising therapeutic paradigm for newly diagnosed SCNSL, yet these hypothesis-generating findings require validation in larger patient cohorts.