case_images: PMC10739420_01
case_images: PET-CT scan and immunohistochemical staining results of FL transforming into DLBCL (GCB subtype). (A): PET-CT imaging showed a bulky mass from the right psoas major muscle to the right pelvic wall (SUVmax was 42.1) and a soft tissue mass in the right groin (SUVmax was 21.2). (B): The immunohistochemical staining results indicated that FL had transformed into DLBCL (GCB subtype) with CD20 negative, Bcl-6 (90%+), MUM1 (90%+), Ki-67 (80%+), Bcl-2 (90%+), c-myc (60%+), CD10 (+), and CD19 (+). (original magnification, 200x). The thin arrows represent the original comparable lesion locations.
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case_images: PMC10739420_01_fimmu-14-1307242-g001.jpg
case_images: f1
case_images: Then, PET-CT scans showed a bulky mass (a maximum diameter of 84 mm) from the right psoas major muscle to the right pelvic wall with increased FDG uptake (SUVmax was 42.1) and a soft tissue mass in the right groin with increased FDG uptake (SUVmax was 21.2) ( Figure 1A ). The third pathological investigation of the right paravascular iliac lesion indicated that the lymphoma had transformed into DLBCL (GCB subtype) that was negative for CD20 and positive for Bcl-6 (90%+), MUM1 (90%+), Ki-67 (80%+), Bcl-2 (90%+), c-myc (60%+), CD10 (+), and CD19(+) ( Figure 1B ).
case_images: PET-CT evaluation before and after ASCT and CAR T-cell infusion. (A): PET-CT examination demonstrated PD before ASCT and CAR T-cell infusion. (B): PET-CT examination demonstrated CMR in the +1 month after ASCT and CAR T-cell therapy. (C): PET-CT examination demonstrated sustained CMR in the +3 month after ASCT and CAR T-cell therapy. The thick arrows represent the positive lesions; thin arrows represent the original comparable lesion locations.
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case_images: PMC10739420_01_fimmu-14-1307242-g002.jpg
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case_images: T-cell infusion indicated PD with a novel intraperitoneal tumor mass near the posterior abdominal wall and other remaining masses ( Figure 2A ). The patient underwent BEAM conditioning (carmustine 300 mg/m2 day -7, etoposide 200 mg/m2 day -6~-3, cytarabine 200 mg/m2 q12h day -6~-3, and melphalan 140 mg/m2 day -2) and ASCT following CD19 CAR T-cell infusion. ASCT ( Figure 2B ). At the last follow-up, the patient received ibrutinib as maintenance therapy and remained in CMR ( Figure 2C ).
case_images: The timeline of ASCT combined with CAR T-cell therapy.
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case_images: TP53, KMT2D, MS4A1, SOCS1 and HIST1H1C were persistently negative after CD19 CAR T-cell infusion following ASCT ( Table 2 ). The timeline of treatment is shown in  Figure 3 .