How would you manage a patient with primary CNS lymphoma who received R-MTX followed by autologous transplant with systemic relapse 5 years later for which R-Pola-CHP was given now followed by CNS relapse?

Dr. @Dr. First Last - certainly an interesting and unusual scenario! I'm presuming that the patient is fit for intensive approaches. This is a patient whom I would consider for CAR-T as a treatment of multiply relapsed DLBCL. Depending on the symptomatic and anatomic burden of the CNS disease, debulking or bridging with either MTX-based therapy (as residual MTX sensitivity would be likely) or stereotactic RT (as opposed to WBRT) or a combination to reduce CNS burden of disease prior to CAR would be relevant considerations.