Early real-world experience with liso-cel:
Dr Robert Lown
An Expert's Perspective
Dr Robert Lown, Consultant Haematologist at University Hospital Southampton NHS Foundation Trust, shares his real-world experience of treating a patient with relapsed DLBCL using liso-cel.2 Please note, individual responses to treatment may vary.
Dr Robert Lown
University Hospital Southampton
This case is one of several liso-cel infusions administered at our centre to date. Although this report focuses on a single patient, I have experience treating a broad range of individuals of various ages and LBCL subtypes. The patient in this case had DLBCL and experienced relapse following first-line chemoimmunotherapy, making CAR T therapy an appropriate next step.
1.
This patient achieved a CMR to liso-cel for 2L treatment of DLBCL – CR rates observed in the primary analysis of TRANSFORM can be found on page 43
2.
The manufacturing period in the CAR T process provides an opportunity to optimise performance status and control disease burden through bridging therapy
3.
Liso-cel offers potential for use in an outpatient setting in appropriately selected patients, as centres progress towards delivering ambulatory CAR T therapy1,4,5
Presentation and diagnosis
- October 2023: 68-year-old woman with a history of long QT syndrome presented with axillary lymphadenopathy; referred to the breast team for investigation
- Biopsy: confirmed non-germinal centred DLBCL
- Genetic testing: MYC rearrangement (no BCL2 or BCL6 rearrangement)
- Stage: IIIBS (advanced disease with spleen involvement)
- IPI score: 2 (based on age and LDH)
Diagram:
Pre-treatment 23/11/2023
First-line treatment and initial response
- Considered for clinical trial, but did not meet inclusion criteria
- Began standard R-CHOP chemotherapy
- Developed mild neuropathy, prompting a reduction in vincristine dose
- Interim PET scan (after 3 cycles) showed a CMR
- Completed all 6 cycles of R-CHOP, then received consolidation radiotherapy (30 Gy x 10 sessions) to the right axilla
- August 2024: PET scan confirmed sustained CMR 12 weeks after radiotherapy
Diagram:
After 5 cycles of R-CHOP 04/03/2024
Follow-up and early concern
- Patient remained clinically well after completing first-line treatment
- March 2025 (11 months after last R-CHOP cycle):
- Slightly elevated LDH (560 units/litre), following persistent mild elevation in LDH since the end of treatment
- Pre-emptive CT scan (before 12-month cut-off for CAR T eligibility) showed slightly increased prominence of mediastinal lymph nodes and new sub-centimetre retroperitoneal nodes
- MDT recommended a repeat PET scan in 3 months to monitor progression
Mediastinal nodes
Retroperitoneal nodes
Recurrence and management
- Four weeks later: patient admitted with acute kidney injury, hypercalcaemia, constipation and abdominal pain, and a new nodal mass on the left side of the neck
- Biopsy confirmed recurrent DLBCL
- Review of pre-month 12 CT scans showed lymph
node progression, consistent with progressive disease per RECIST criteria - MDT and patient discussion considered CAR T therapy vs high-dose chemotherapy
- After reviewing patient fitness and disease biology, CAR T therapy was selected
Diagram:
23/05/2025
Rationale for choosing CAR T therapy
This patient was an excellent candidate for CAR T therapy. She had a strong response to steroids, and her performance status improved rapidly (to ECOG 1); hypercalcemia and kidney injury resolved quickly. She experienced a late recurrence, so we felt confident she would respond to bridging chemotherapy. She had a robust lymphocyte count of 1.4 × 109/L. With no eligibility concerns identified, we made the decision to proceed with liso-cel.
— Dr Robert Lown
CAR T therapy timeline
Manufacturing turnaround time is always a consideration in CAR T therapy, but in my experience with liso-cel, it has not been a barrier to treatment. During this time, we focus on maintaining patient stability through bridging therapy, improving performance status and controlling disease burden. These measures are essential to ensure patients are in the best possible condition for infusion.
— Dr Robert Lown
CAR T Infusion
- Lymphodepletion: given in an ambulatory setting; patient, admitted Day –1 prior to infusion
- Infusion: administered without complication
- Treatment course: no CRS, ICANS or infection occurred
- Day 14: discharged via early-discharge pathway
- Day 28: PET scan confirmed ongoing CMR
Diagram:
Day 28 post-infusion 19/08/2025
Blood Results
Haematological toxicity
Immunoglobulins
Blood results followed the expected pattern. There were two drops in neutrophil counts, which responded well to G-CSF. Platelet counts decreased, but never to a level requiring transfusion or growth factor support. Immunoglobulin levels also fell, and I expect they will remain low.
— Dr Robert Lown
Final Remarks
In my experience, liso-cel has consistently delivered efficacy with a safety profile consistent with reported trial data. PET confirmed ongoing CMR at three months, which continued to be observed at six months.
We were pleased with this outcome given the high-tempo chemo- and radio-refractory disease. She has done really well with liso-cel.
Our experience with liso-cel to date gives us confidence to work towards an ambulatory delivery model. As a pro-ambulatory centre, we are taking a stepwise approach to eventually offering ambulatory care to every patient for whom it is appropriate. Ambulatory care has the potential to allow patients
to recover in a comfortable, non-hospital environment, with the support of family and friends.6,7
— Dr Robert Lown
Diagram:
Month 3 post-infusion
This patient case report was authored and provided by Dr Robert Lown, who has received honoraria and consultancy fees from Bristol Myers Squibb Pharmaceuticals Limited.
Abbreviations
2L, second line; AE, adverse event; CAR T, chimeric antigen receptor T-cell; CMR, complete metabolic response; CR, complete response; CRS, cytokine release syndrome;
CT, computed tomography; DLBCL, diffuse large B-cell lymphoma; ECOG, Eastern Cooperative Oncology Group; EFS, event-free survival; FL, follicular lymphoma; FL3B, follicular lymphoma grade 3B; G-CSF, granulocyte-colony stimulating factor; HGBCL, high grade B-cell lymphoma; HSCT, haematopoietic stem cell transplantation; ICANS, immune effector cell–associated neurotoxicity syndrome; IPI, International Prognostic Index; LBCL, large B-cell lymphoma; LDH, lactate dehydrogenase; liso-cel, lisocabtagene maraleucel; LTFU, long-term follow-up; MDT, multidisciplinary team; NCCP, National CAR T Clinical Panel; NE, neurological event; NHS, National Health Service; NR, not reached; OS, overall survival; PET, positron emission tomography; PFS, progression-free survival; PMBCL, primary mediastinal large B-cell lymphoma; QP, qualified person; R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone; RECIST, Response Evaluation Criteria in Solid Tumours; R-GDP, rituximab, gemcitabine, dexamethasone, platinum; R/R, relapsed/refractory; SOC, standard of care.
References
- Bristol Myers Squibb. BREYANZI® SmPC. 9 January 2026. Available at: https://www.medicines.org.uk/emc/product/100499/smpc.
- Lown R, personal case and professional opinion ;
- Abramson JS, et al. Blood. 2023;141(14):1675–84;
- Linhares Y, et al. Blood Adv. 2024;8(23):6114–26;
- Kamdar M, et al. Lancet. 2022;399(10343):2294–308;
- Cambridge University Hospitals NHS Foundation Trust. Ambulatory care of adults undergoing CAR-T therapy.11 August 2025. Available at: https://www.cuh.nhs.uk/patient-information/ambulatory-care-of-adults-undergoing-car-t-therapy/.
- McEntee N, et al. Semin Oncol Nurs. 2025;41(1):151758;
- Kamdar M, et al. Poster presentation ASH 2025; Poster 3710.
© 2026 Bristol Myers Squibb Pharmaceuticals Limited.
BREYANZI® (lisocabtagene maraleucel) is a trademark of Bristol Myers Squibb.
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A downloadable PDF version of this case study is available for reference. This document contains the full details presented on this page.
2009-GB-2600117 | August 2026