PMC10063779_01
C-myc gene, IgH/BCL2 gene and BCL6 gene translocation detection (in the 100 tumor cells counted, more than 15% of the separation signals were interpreted as positive). Fluorescence in situ hybridization confirmed the presence of MYC, while BCL2 and BCL6 genes were negative.
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The patient was diagnosed with IV stage BL ( Figure 1 ).
Videography results of relapsed/refractory Burkitt's lymphoma with TP53 mutations. (A) PET before CAR T cell therapy. (B) PET after CAR T cell therapy. (C) PET after CAR19 and CAR22 T cell cocktail therapy following ASCT. (D) The latest PET.
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Figure 2A ). Fluorescence in situ hybridization confirmed the presence of MYC, while BCL2 and BCL6 genes were negative. PET-CT showed that the metabolism of soft tissue masses in the left submandibular region reduced, suggesting that some lymphoma infiltration activities were inhibited after treatment ( Figure 2B ). In November, the PET-CT showed a little flaky soft tissue shadow in the left submandibular area, and the metabolism did not increase ( Figure 2C ). Then, the latest PET/CT showed the size of the lymph nodes in the right cervical region II was similar, and metabolism reduced slightly, compared with the previous PET/CT images (December 17, 2019) ( Figure 2D ).
The therapeutic response of CAR19 and CAR22 T cell cocktail therapy following ASCT. (A) Dynamic changes in IL-6 and ferritin after CAR-T cell infusion. (B) Dynamic changes in IL-6 and ferritin after CAR19 and CAR22 T cell cocktail therapy following ASCT. (C) Liquid biopsy results. The proportion of circulating tumor DNA mutations at locus TP53 c.376-1G>A was measured and the results were expressed as the ratio (percentage) of copy numbers of the target gene and the internal reference gene.
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After sequential infusion of anti-CD19 and anti-CD22 CAR-T cells, cytokine release syndrome (CRS) was observed, and interleukin-6 and ferritin increased slightly and transiently ( Figure 3A ). Continuous renal replacement therapy (CRRT), plasma change and high-dose methylprednisolone pulse therapy was performed for severe CRS (Grade 4). After infusion for 10 days, the neck mass was substantially reduced and the texture softened. CD19 CAR T were 0.67*10^6/kg and 0.64*10^6/kg, respectively (August 19 and 23, 2018). CRS was also observed during this period ( Figure 3B ). Peripheral blood lymphocyte subsets suggest that CD19+B cells are 0%; liquid biopsy showed 0% TP53 mutation ( Figure 3C ).
The timeline of the clinical treatment and disease status.
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The timeline of the clinical treatment and disease status were shown in  Figure 4 .