%A Accorsi Buttini,Eugenia
%A Farina,Mirko
%A Lorenzi,Luisa
%A Polverelli,Nicola
%A Radici,Vera
%A Morello,Enrico
%A Colnaghi,Federica
%A Almici,Camillo
%A Ferrari,Emilio
%A Bianchetti,Andrea
%A Leoni,Alessandro
%A Re,Federica
%A Bosio,Katia
%A Bernardi,Simona
%A Malagola,Michele
%A Re,Alessandro
%A Russo,Domenico
%D 2023
%J Frontiers in Oncology
%C
%F
%G English
%K CAR T-cell therapy,myelodysplastic syndrome,diffuse large B cell lymphoma,next generation sequencing,Clonal hematopoiesis
%Q
%R 10.3389/fonc.2023.1036455
%W
%L
%M
%P
%7
%8 2023-January-20
%9 Case Report
%+ Eugenia Accorsi Buttini,Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia,Italy,eugenia.accorsi@gmail.com
%#
%! HR-MDS following CAR T-cell therapy
%*
%<
%T High risk-myelodysplastic syndrome following CAR T-cell therapy in a patient with relapsed diffuse large B cell lymphoma: A case report and literature review
%U https://www.frontiersin.org/articles/10.3389/fonc.2023.1036455
%V 13
%0 JOURNAL ARTICLE
%@ 2234-943X
%X BackgroundChimeric antigen receptor (CAR) T-cell therapy represents the most advanced immunotherapy against relapsed/refractory B cell malignancies. While cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome are distinctive, known CAR T-cell acute adverse events, hematological toxicity has been increasingly reported. Cytopenia following CAR T-cell treatment is attributed in most cases to lymphodepletion regimens, bridging chemotherapy, or radiotherapy. However, when cytopenia becomes prolonged, the development of myelodysplastic syndrome (MDS) should be considered.Case presentationWe report a case of high risk (HR)-MDS following CAR T-cell therapy in a patient with relapsed diffuse large B cell lymphoma. Eight months after CAR T-cell infusion, the blood count showed progressive, worsening cytopenia and the bone marrow biopsy revealed multilineage dysplasia without excess of blasts associated with chromosome 7 deletion and RUNX1 mutation. Next generation sequencing analysis, retrospectively performed on stored samples, showed a germ line CSF3R mutation, CEBPA clonal hematopoiesis, but no RUNX1 lesion.ConclusionWe describe a case of HR-MDS, with deletion of chromosome 7 and acquisition of RUNX1 mutation, developing after CAR T-cell therapy in a patient with clonal hematopoiesis (CH). Previous chemotherapy favored MDS onset; however, we could not exclude the fact that the impairment of immunosurveillance related to either lymphodepletion or CAR T-cell infusion may play a role in MDS development. Thus, we designed a multicenter prospective study (ClonHema-CAR-T-Study) to investigate if cytopenia after CAR T-cell treatment may be due to underling CH as well as the presence of secondary myeloid malignancies.