Anaphylaxis During CAR T-Cell Infusion in an HIV-Positive Patient With High-Grade B-Cell Lymphoma: A Case Report and Literature Review.

Chimeric antigen receptor (CAR) T-cell therapy is a highly effective treatment for relapsed or refractory large B-cell lymphoma (LBCL), but clinical experience in people living with HIV (PLWH) remains limited due to their exclusion from pivotal trials. We report the case of a 55-year-old man with HIV and high-grade B-cell lymphoma who developed severe anaphylaxis during axicabtagene ciloleucel (axi-cel) infusion, requiring early termination after approximately 50% of the planned dose was delivered. The patient experienced only Grade 1 cytokine release syndrome and no neurotoxicity. Despite incomplete infusion, he achieved a sustained partial metabolic response on PET/CT imaging at Days +30, +60, and +110 post-infusion. HIV remained well-controlled throughout, and no infectious complications were observed. This case highlights both the feasibility of administering CAR T-cell therapy in virologically suppressed PLWH and the potential for clinical benefit even with partial cell delivery. In addition, it draws attention to anaphylaxis as a rare but serious infusion-related adverse event. To our knowledge, this is the first report of anaphylaxis to axi-cel in a PLWH. The case underscores the need for enhanced pharmacovigilance and pre-infusion risk assessment. It also supports growing evidence that PLWH should not be categorically excluded from CAR T-cell access or clinical trials.