PMC9209652_01
Summary of the patient's treatment history. (A) Multiple bone metastases before second-line treatment. (B) Multiple bone metastases after two cycles of therapy. (C) Reduction of multiple bone metastases after six cycles of therapy. (D) Continued reduction of multiple bone metastases after 3 months of maintenance therapy. (E, I) Multiple lung metastases before second-line treatment. (F, J) Multiple lung metastases after two cycles of therapy. (G, K) PR of multiple lung metastases after six cycles of therapy. (H, L) Disappearance of lung metastases after 3 months of maintenance therapy. (M) Clustered tumor cells confirmed bone marrow involvement before second-line treatment. (N) Scattered tumor cells detected after four cycles of therapy. (O) Suspicious tumor cells detected after six cycles of therapy. (P) Bone marrow aspiration negative after 3 months of maintenance therapy. PR, partial response; PFS, progression-free survival.
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The diagnostic and treatment history of the patient is shown in  Figure 1 . BMI was detected from bone marrow aspiration and biopsy ( Figure 1M ). Metastatic tumor cells could still be detected from bone marrow biopsy after 4 and 6 cycles of treatment on February 19, 2021, and April 9, 2021 ( Figures 1N, O ). Eventually, his bone marrow biopsy turned negative after 3 months of capecitabine plus sintilimab maintenance chemotherapy and immunotherapy on July 28, 2021 ( Figure 1P ).
Alkaline phosphatase and lactase dehydrogenase changes during treatment (U/L).
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The dynamic changes of ALP and LDH over the treatment are exhibited in  Figure 2 .
Reconstitution kinetics in immune cells in the peripheral blood. (A) The percentages of CD3+, CD4+, and CD8+ cells in live cells during treatment. (B) The percentages of IFNr+, TNFa+, and Granz B+ cells in CD4+ cells during treatment. (C) The percentages of IFNr+, TNFa+, and Granz B+ cells in CD8+ cells during treatment.
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Reconstitution kinetics in immune cells in the peripheral blood during the period of maintenance treatment is shown in  Figure 3 .