PMC8138201_01
(A) Serial MR images one week before (baseline) and three months after CAR T-EGFRvIII infusion. Left sided images are axial post contrast T1 weighted images and right sided images are axial FLAIR images. Note, minimal increase in size of the enhancing lesion in the left temporal lobe at follow-up time-points. (B) Serial MRI examinations after the patient's second surgery. The baseline is one month after her second surgery. White arrows at 15, 21- and 25-month follow-up periods indicate the increasing signal abnormality in the right periventricular region on FLAIR images.
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MRI demonstrated increased size of the enhancing lesion with increasing FLAIR abnormality, concerning for tumor progression vs. treatment response, the latter supported by decreased tumor relative cerebral blood volume (rCBV) ( Figures 1A, B ). After 15 months, serial MRIs revealed gradual tumor progression (arrows,  Figure 1B ).
Timeline of disease progression and treatment. Black bordered months indicate diagnosis or definitive progression on surveillance MRI. The graph shows CAR T-EGFRvIII levels in the peripheral blood as measured by qPCR.
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The patient enjoyed good functional status and received no additional chemotherapy for 18 months following her second operation ( Figure 2 ).