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

• DOI: 10.3389/fonc.2023.1036455
• Publication Date: 2023-01-20T14:37:26Z
• Authors: Eugenia Accorsi B...; Mirko Farina; Luisa Lorenzi; Nicola Polverelli; Vera Radici; Enrico Morello; Federica Colnaghi; Camillo Almici; Emilio Ferrari; Andrea Bianchetti; Alessandro Leoni; Federica Re; Katia Bosio; Simona Bernardi; Michele Malagola; Alessandro Re; Domenico Russo
• Keywords: Cytopenia; Cytokine Release Syndrome

Chimeric 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 are distinctive, known CAR acute adverse events, hematological toxicity has been increasingly reported. Cytopenia following treatment is attributed in cases to lymphodepletion regimens, bridging chemotherapy, or radiotherapy. However, when cytopenia becomes prolonged, development of myelodysplastic (MDS) should be considered.We report a case high risk (HR)-MDS patient with relapsed diffuse large lymphoma. Eight months after infusion, blood count showed progressive, worsening bone marrow biopsy revealed multilineage dysplasia without excess blasts associated chromosome 7 deletion RUNX1 mutation. Next generation sequencing analysis, retrospectively performed on stored samples, germ line CSF3R mutation, CEBPA clonal hematopoiesis, but no lesion.We describe HR-MDS, acquisition developing hematopoiesis (CH). Previous chemotherapy favored MDS onset; however, we could not exclude fact that impairment immunosurveillance related either infusion may play role development. Thus, designed multicenter prospective study (ClonHema-CAR-T-Study) investigate if due underling CH as well presence secondary myeloid