Circulating tumor DNA determining hyperprogressive disease after CAR-T therapy alarms in DLBCL: a case report and literature review

Jiajie He; Jiajie He; Jiajie He; Rui Zou; Rui Zou; Rui Zou; Liqing Kang; Liqing Kang; Lingzi Yu; Lingzi Yu; Lingzi Yu; Peng Wang; Peng Wang; Yang Shao; Junheng Liang; Depei Wu; Depei Wu; Zhengming Jin; Zhengming Jin; Changju Qu; Changju Qu

doi:10.3389/fonc.2023.1283194

Frontiers in Oncology (Nov 2023)

Circulating tumor DNA determining hyperprogressive disease after CAR-T therapy alarms in DLBCL: a case report and literature review

Jiajie He,
Jiajie He,
Jiajie He,
Rui Zou,
Rui Zou,
Rui Zou,
Liqing Kang,
Liqing Kang,
Lingzi Yu,
Lingzi Yu,
Lingzi Yu,
Peng Wang,
Peng Wang,
Yang Shao,
Junheng Liang,
Depei Wu,
Depei Wu,
Zhengming Jin,
Zhengming Jin,
Changju Qu,
Changju Qu

Affiliations

Jiajie He: Suzhou Medical College of Soochow University, The First Affiliated Hospital of Soochow University, Suzhou, China
Jiajie He: National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
Jiajie He: Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
Rui Zou: Suzhou Medical College of Soochow University, The First Affiliated Hospital of Soochow University, Suzhou, China
Rui Zou: National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
Rui Zou: Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
Liqing Kang: School of Chemistry and Molecular Engineering, East China Normal University, Shanghai, China
Liqing Kang: Department of Medical Affairs, Shanghai Unicar-Therapy Bio-medicine Technology Co., Ltd, Shanghai, China
Lingzi Yu: Suzhou Medical College of Soochow University, The First Affiliated Hospital of Soochow University, Suzhou, China
Lingzi Yu: National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
Lingzi Yu: Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
Peng Wang: National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
Peng Wang: Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
Yang Shao: Department of Medical Affairs, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, China
Junheng Liang: Department of Medical Affairs, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, China
Depei Wu: National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
Depei Wu: Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
Zhengming Jin: National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
Zhengming Jin: Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
Changju Qu: National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
Changju Qu: Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China

DOI: https://doi.org/10.3389/fonc.2023.1283194
Journal volume & issue: Vol. 13

Abstract

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Chimeric antigen receptor T-cell therapy (CAR-T) has been widely applied in the clinical practice of relapse/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) due to its promising effects. Hyperprogressive disease (HPD) has gained attention for rapid tumor progression and has become a therapeutic and prognostic challenge. Here, we present a patient who had suffered from several recurrences previously and controlled well with a very small tumor lesion left was infused with CD19/CD22 bispecific CAR-T, with no immune effector cell-associated neurotoxicity syndrome, or cytokine release syndrome observed. However, rapid deterioration, subsequent imaging examination, circulating tumor DNA, and serum biomarkers detection identified HPD. The patient did not respond to salvage treatment and died 40 days after infusion. To our knowledge, only one case of HPD in DLBCL after CAR-T therapy has been reported. This fatal case alarmed the risk of HPD and the ctDNA profile monitoring we used was performed as a non-invasive method to diagnose HPD, providing far-reaching practical instruction for CAR-T therapy.

Published in Frontiers in Oncology

ISSN: 2234-943X (Online)
Publisher: Frontiers Media S.A.
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.frontiersin.org/journals/oncology/

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