case_images: PMC9731404_01
case_images: Immunophenotypic analysis by flow cytometry revealed a common B-cell acute lymphoblastic leukemia. There were 21% lymphoblasts expressing CD19+ in the bone marrow at the time of post-transplant recurrence, represented in red.
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case_images: However, in January 2019, 21% of lymphoblasts were detected in the bone marrow by morphological analysis and flow cytometry ( Figure 1 ).
case_images: Clinical evolutions after CAR-T cells infusion. (A) Measures of body temperature after CAR-T cells infusion, the plot showed the maximum temperature was 39 C on day 7. (B) Levels of cytokines IL-6 and CRP were monitored at the indicated time points after CAR-T cells infusion. IL-6 and CRP peaked on day 7. (C) The vector copy number of anti-CD19 CAR in peripheral blood was detected by PCR. The highest anti-CD19 CAR DNA copy number was 108,140 copies/microg DNA on day 10. IL-6, interleukin-6; CRP, C reactive protein; PCR, polymerase chain reaction.
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case_images: Body temperature, cytokine levels, and c-reactive protein (CRP) were monitored ( Figures 2A, B ). The copy number of anti-CD19 CAR in peripheral blood reached its peak on day 10, which was 1.08x105 copies/mug.DNA ( Figure 2C ).
case_images: Summary of clinical course. FC, fludarabine and cyclophosphamide regimen; CAR-T cell, chimeric antigen receptor T cell; MRD, minimal residual disease; IFN- alpha, interferon-alpha.
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case_images: The main clinical process of the patient is summarized in  Figure 3 .