PMC8339712_01
Cervical lymph node biopsy (A) and immunophenotypic analysis (B) of case 1 by flow cytometry revealed a CD20-negative EBV-PTLD; Computed tomography and positron emission tomography images before (C) and after treatment (D); Timeline of EBV PCR and clinical data (E); CRP, sIL6 (F) and peripheral hemogram (G) after CAR-T infusion.
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However, CD20 was almost negative ( Figures 1A, B ). PET-CT detected hypermetabolic lesions and the involvement of the 86 cervical lymph nodes ( Figure 1C ). T cells were collected for CAR-T preparation. Then, he received a total dose of 2 x 106/kg anti-CD22 and 2 x 106/kg anti-CD19 donor-derived CAR-T infusion from days 68 to 69. The timelines of EBV PCR and related treatments are depicted in  Figure 1E . On day 4 post-CAR-T infusion, the patient had grade 1 CRS presenting as fever and slightly elevated CRP/sIL6 ( Figure 1F ), resolved fully by symptomatic and supportive treatment. Although grade 4 neutropenia and thrombocytopenia were prolonged for approximately 2 weeks ( Figure 1G ), the patient's cervical lymphadenopathy improved and responded well to CAR-T therapy.
PMC8339712_02
Cervical lymph node biopsy of case 2 (A); Computed tomography and positron emission tomography images before (B) and after treatment (C);Timeline of EBV PCR and clinical data (D); CRP, sIL6 (E) and peripheral hemogram (F) after CAR-T infusion.
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Figures 2A, B ). Furthermore, tumor-associated EBV was detected by EBER in situ hybridization. The follow-up PET-CT scan showed complete metabolic remission ( Figure 2C ). The timelines of EBV PCR and related treatments were shown in  Figure 2D . CRP, sIL6 and peripheral hemogram after CAR-T infusion were summarized in  Figures 2E, F .