PMC9897055_01
Patient's timeline. Top: mutational profile detected by next generation sequencing. Middle: the main patient treatments. Changes of hemoglobin and platelets from the beginning of patient therapy to 9 months after CAR T cell-therapy are shown.
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In the following months, the blood count showed a progressive normalization of leukocytes values, with hemoglobin ranging between 8.5 and 10.4 g/dl and platelets between 20 and 40 x10 /L ( Figure 1 ). Seven months later, the cytopenia worsened (grade III anemia, grade IV thrombocytopenia, grade III leukopenia), requiring recombinant human G-CSF and erythrocyte and platelet support. In December 2022, a BM biopsy ruled out lymphoma infiltration but revealed multilineage dysplasia without excess of blasts ( Figure 2 ), associated with chromosome 7 deletion.
BM biopsy performed eight months after CAR T-cell infusion. Myeloid maturation is shifted to the left, granulocytes are rare and hyposegmented. The megakaryopoiesis is hypoplastic (LAT stain) and erythroid precursors show megaloblastoid features (E-caherin stain).
fonc-13-1036455-g002.jpg
PMC9897055_01_fonc-13-1036455-g002.jpg
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In the following months, the blood count showed a progressive normalization of leukocytes values, with hemoglobin ranging between 8.5 and 10.4 g/dl and platelets between 20 and 40 x10 /L ( Figure 1 ). Seven months later, the cytopenia worsened (grade III anemia, grade IV thrombocytopenia, grade III leukopenia), requiring recombinant human G-CSF and erythrocyte and platelet support. In December 2022, a BM biopsy ruled out lymphoma infiltration but revealed multilineage dysplasia without excess of blasts ( Figure 2 ), associated with chromosome 7 deletion.