CASE REPORT article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Sequential Pseudoallogeneic CAR20/22/19 T-Cell Therapy in Patient with Diffuse Large B-Cell Lymphoma Relapse after Allo-HSCT: A Case Report
Provisionally accepted
- 1Zhongnan Hospital of Wuhan University, Wuhan, China
- 2Department of Hematology and Lymphoma Research Center, Beijing Gobroad Boren Hospital, Beijing, China
- 3Beijing Gobroad Boren Hospital, Beijing, China
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Purpose: The prognosis for patients with refractory/relapsed diffuse large B-cell lymphoma (R/R DLBCL) is dismal. Recurrence in R/R DLBCL is mostly determined by antigen loss or mutation and limited in vivo survival of chimeric antigen receptor (CAR) T cells. Methods: A 38-year-old female patient was diagnosed with the left breast DLBCL in March 2018. After undergoing immuno-chemotherapy, autologous stem cell transplantation, and radiotherapy, she relapsed in May 2019. The peripheral blood (PB) morphology shows 36% of cells classified as unknown. The bone marrow (BM) smear showed 71% of abnormal lymphocytes. BM flow cytometric (FCM) analysis revealed 70.24% abnormal phenotype of mature B lymphocytes. The patient's abnormal karyotype is complex and the 17th chromosome is missing. The p53 gene deletion (accounts for about 82%) was revealed by fluorescence in situ hybridization (FISH) investigation. Results: Autologous CD19 CAR-T cells were infused after lymphodepletion chemotherapy with cyclophosphamide and fludarabine. The patient experienced Grade I cytokine release syndrome (CRS) and went into complete remission (CR). The genetic susceptibility gene test results suggest that the patient has potential susceptibility gene mutations for hematological tumors, then, allogeneic hematopoietic stem cell transplantation (allo-HSCT) was conducted as consolidation therapy. Unfortunately, the patient was relapsed five months after allo-HSCT. Than, the patient recevied sequential pseudoallogeneic CAR20/22/19 T-cell therapy. The patient is currently at 4 years after allo-CAR-T treatment with BM morphology CR, negative minimum residual disease, complete donor chimerism, and no GVHD. Conclusion: Our findings suggest that pseudoallogeneic CAR-T therapy was safe and effective in patient with DLBCL who experience relapse after allo-HSCT. Sequential administration of CAR20/22/19 T-cell may have reduced the antigen escape relapse in DLBCL. For patients with DLBCL relapse after allo-HSCT, larger trials are required to validate the safety and effectiveness of pseudoallogeneic CAR-T therapy as well as its ability to lower the rate of antigen escape relapse.
Keywords: Refractory/Relapsed diffuse large B-cell lymphoma, pseudoallogeneic CAR-T, cytokine release syndrome, Autologous stem cell transplantation, allogeneic hematopoietic stem cell transplantation
Received: 17 Aug 2025; Accepted: 21 Nov 2025.
Copyright: © 2025 Xiong, Feng, Liu, ZHENG, Deng, Li and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Defeng Zhao, 2633195912@qq.com
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