case_images: PMC10577281_01
case_images: CD19 and CD22 CAR-T cell cocktail therapy for B-ALL. (A), The CAR19 and CAR 22 transfection rate determined by flow cytometry are 35.6% and 40.9%, respectively. (B), The expansion of CAR-T cells in the PB measured by the CAR-contained lentivirus copies. (C), Levels of IL-6 during CAR-T cell therapy. (D), Levels of ferritin during CAR-T cell therapy. (E), Numbers of WBC and lymphocyte during CAR- T cell therapy.
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case_images: The transfection rates of CD19 CAR and CD22 CAR were 35.6% and 40.9%, respectively (Figure 1A). As shown in Figure 1B, CAR-T cells expanded well in vivo with CD19 and CD22 CAR copy numbers of 1,034,286 and 52,857.14 per microg genomic DNA, respectively, on day 6. Laboratory testing revealed markedly increased levels of IL-6 and ferritin after CAR-T cell infusion, as shown in Figures 1C, D, with peak values of 1,260 pg/mL and 30,014 microg/L on day 6 and day 8, respectively. In addition, the patient experienced severe myelosuppression but recovered two weeks later, as depicted in Figure 1E.
case_images: CMV reactivation. (A), B cells in peripheral blood determined by flow cytometry is 0% three months after CAR-T cell infusion. (B), The image of chest X-ray showed prominent interstitial infiltration. (C), The dynamic changes of the number of WBC, lymphocyte and platelet after the use of ganciclovir or penciclovir.
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case_images: The primary disease was well controlled, and B cells were still absent (Figure 2A). The findings on chest X-ray suggested pulmonary infection and interstitial infiltration (Figure 2B). WBC count and platelet count decreased progressively (Figure 2C). We stopped penciclovir on December 18 when the clinical symptoms had improved.
case_images: Timeline of disease progression and relevant treatment. B-ALL, acute B-cell lymphoblastic leukemia. +8m/+5m: 8/5 months later. Allo-HSCT: allogeneic hematopoietic stem cell transplantation. FACS: Fluorescence activated Cell Sorting. BM: bone marrow. FC: fludarabine (25 mg/m2) and cyclophosphamide (20 mg/kg per day). +1d: 1 day later. The same principle for +14d, +41d, +92d and +38d. CRS, cytokine release syndrome; ICANS, Immune effector cell-associated neurotoxicity syndrome; CR, complete remission; PB, peripheral blood.
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case_images: The key events in this case are summarized in Figure 3.