PMC7183776_01
Changes in head nodules and PET-CT. (A) The nodules appeared when the disease recurred. (B) The nodules had no significant changes 28 days after anti-CD123-CAR T-cell therapy. (C) The nodules disappeared 28 days after radiotherapy. (D) PET-CT results before the combination therapy. (E) PET-CT results after the combination therapy.. Abbreviations: PET-CT, positron emission tomography-computed tomography; CAR, chimeric antigen receptor.
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However, in July 2019, painless nodules appeared in his head (Figure 1A). Positron emission tomography-computed tomography (PET-CT) showed that the metabolism of masses in his head increased with a standardized uptake value of 18.9 (Figure 1D). T-cells and the level of CD123-CAR gene DNA in the peripheral blood (Figure 2B, C). There were no significant changes in the nodules 28 days after anti-CD123-CAR T-cell infusion (Figure 1B). T-cells, the level of CD123-CAR gene DNA, and the serum levels of cytokines in the peripheral blood reached higher peaks 42 days after anti-CD123-CAR T-cell infusion, or 14 days after radiotherapy (Figure 2). The nodules in his head disappeared gradually 28 days after radiotherapy (Figure 1C). No abnormal metabolism throughout his body could be identified by PET-CT (Figure 1E).
The changes of the levels of cytokines and CD123-CAR gene DNA, and the changes of the proportion of anti-CD123-CAR T-cells. (A) The serum levels of cytokines reached higher peaks 42 days after anti-CD123-CAR T-cell infusion or 14 days after radiotherapy. (B) The proportion of anti-CD123-CAR T-cells reached higher peaks 42 days after CAR-T cell infusion or 14 days after radiotherapy. (C) The trend of the CD123-CAR gene DNA level is the same as that of the anti-CD123-CAR T-cell proportion.. Abbreviation: DNA, deoxyribonucleic acid.
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T-cell therapy was well tolerated in this patient with grade 1 cytokine release syndrome (CRS). The adverse events (AEs) were manifested by fever up to 39.0 C without chills three days after infusion, accompanied by slight dizziness and weakness. These AEs related to the anti-CD123-CAR T-cell therapy were relieved eight days after infusion. The highest serum level of interleukin 6 (IL-6) was only 8.02 pg/mL on day 4. There were no significant peaks in other cytokines such as the IL-8, IL-10 and tumor necrosis factor-alpha (TNF-alpha) (Figure 2A). T-cells and the level of CD123-CAR gene DNA in the peripheral blood (Figure 2B, C). There were no significant changes in the nodules 28 days after anti-CD123-CAR T-cell infusion (Figure 1B). The levels of serum cytokines and the level of CD123-CAR gene DNA in the peripheral blood were very low (Figure 2). T-cell therapy (Figure 2B). The patient received a local radiotherapy for the nodules in his head. The radiation dose was 1.8 Gy each time, 16 times in total (28.8 Gy total dose). T-cells, the level of CD123-CAR gene DNA, and the serum levels of cytokines in the peripheral blood reached higher peaks 42 days after anti-CD123-CAR T-cell infusion, or 14 days after radiotherapy (Figure 2). The nodules in his head disappeared gradually 28 days after radiotherapy (Figure 1C).