Diffuse large B-cell lymphoma (DLBCL) constitutes 30% of non-Hodgkin lymphomas and is often curable with frontline chemoimmunotherapy. However, in some patients, remission cannot be achieved, and this situation necessitates the application of second, third or even fourth-line salvage therapies. The limited treatment options for relapsed or refractory (r/r) DLBCL underscore an unmet clinical need, which urges the development of new therapies for this patients. Glofitamab is a humanized IgG1 bispecific monoclonal antibody binds to CD20 on malignant B lymphocytes and to CD3 on cytotoxic T cells with promise for treating r/r DLBCL. Here we present a primary refractory DLBCL patient to whom we applied glofitamab treatment as the 5th line.

A 28-year-old male patient was diagnosed with stage IV germinal center DLBCL biopsy of sacral mass. The patient received dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) as first-line treatment. However, progression was detected by 18F-Fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) with computed tomography (CT). Then, rituximab plus ifosfamide, carboplatin, etoposide (R-ICE), ifosfamide gemcitabine vinorelbine prednisolone (IGEV), salvage radiotherapy (RT), rituximab plus bendamustine (R-B) therapies were given, respectively. Since no response was obtained to all these treatments, glofitamab was started as the 5th line therapy. After the twelve cycles of glofitamab therapy, the patient achieved complete remission (CR). Four months post-treatment, he was still alive.

Glofitamab is approved as a third-line treatment for r/r DLBCL, inducing a CR in nearly 40% of patients in this situation. According to literature, CR can be maintained for years after completion of glofitamab treatment. Data from a follow-up in a cohort of patients who were treated with glofitamab showed a median duration of complete response of 34 months. Our case post-treatment fourth months was still alive. This case indicates that glofitamab is quite effective primary refractory DLBCL.