A 72-year-old woman with DLBCL treated with six cycles of R-CHOP, as well as two doses of intrathecal methotrexate, presented with progressive limb weakness and numbness over several weeks. Examination revealed 3/5 intrinsic hand muscles, 4/5 bilateral hip flexors, 2/5 left foot plantar/dorsiflexion, 1/5 in the right foot and absent patellar/Achilles reflexes bilaterally. Sensation was decreased to all modalities below the ankles.
EMG/NCS demonstrated severe symmetrical sensorimotor demyelinating polyneuropathy with active and chronic denervation. She received 2g/kg IVIG with limited benefit. She was refractory to additional MATRix chemotherapy. Ultimately, she proceeded with lisocabtagene maraleucel (liso-cel) CAR-T.
She had CRS grade 1 (fever) treated with tocilizumab and dexamethasone. She had a single drop in her ICE score to 9/10, but this resolved. She was safely discharged on post-infusion Day 8.
Examination was improved three months later with 4+/5 hip flexion, 4-5/5 dorsiflexion and plantarflexion bilaterally, normal patellar reflexes, absent ankle jerk. She could mobilize independently. She had no evidence of disease on PET/CT until a recurrence 8 months later successfully treated with rituximab, lenalidomide, and zanubrutinib.