PMC8092435_01
The disease history of the patient. The blue circle indicates the lesion.
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Arbor stage IV). A brief introduction of disease history was presented in  Figure 1 .
(A) intravenous infusion of CAR-T cells; (B) local injection of CAR-T cells; (C) the changes of mass after CAR-T cell treatment; (D) the CAR-T cell kinetics during the treatment process; (E) B cell depletion during the treatment process; (F) Change in cytokines levels during the treatment process.
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To increase the number of CAR-T cells in local lesions to enhance the efficacy, we used a new strategy that combined intravenous infusion and local injection of CAR-T cells ( Figures 2A, B ). A total of six sites were selected for the local injection (four sites at the base of the mass and two sites at the top of the mass), each of the six sites were injected with 0.5 ml CAR-T cells ( Figure 2B ). About 2 h after the CAR-T cells therapy, the CAR-T cell was detectable in the peripheral blood and reached its highest peak on day 14; it was almost undetectable on day 28 ( Figure 2D ). Besides, flow cytometry showed B cells in the peripheral blood had decreased from day 1 of CAR-T cells administered level to undetectable level on day 14; the B cells remained unrecovered on day 28 ( Figure 2E ). The serum levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor alpha slightly fluctuated in the normal range ( Figure 2F ). We advised the patient to return for a follow-up visit within six months, and six months after CAR-T cell therapy, the patient had no discomfort, the mass had disappeared, and the newly formed skin was flat ( Figure 2C ).