{
  "abstract": "We describe a case of secondary peripheral T-cell lymphoma (PTCL) arising from infused CD19/CD22-4-1BB-CD3ζ-lenti bispecific chimeric antigen receptor (CAR)-T cells in a patient with relapsed or refractory B-cell lymphoma who carried a pathogenic germline BLM p.L107Ffs*36 variant. Integrated genomic and molecular analyses confirmed that the PTCL was clonally derived from the infused CAR-T product and revealed a multistep oncogenic process involving pre-existing driver mutations (BLM), somatic TET2 mutations (p.R1261H and p.E1755*), and genomic instability. Clonal CAR vector integration events in cancer-associated genes (NF1, CBX5, RNF213, etc) were identified as markers of clonal expansion, although no functional evidence supports a direct oncogenic role. We acknowledge that this case lies on a spectrum between clonal lymphoproliferative disorder and overt PTCL, and terminology continues to evolve. This case suggests a need for re-biopsy of suspected relapses after CAR-T therapy and highlights the limitations of conventional product assessment in detecting premalignant clones.",
  "authors": [
    {
      "affiliations": [
        "Department of Hematology, Beijing Tongren Hospital CMU, Beijing, China"
      ],
      "name": "Xindi Liu"
    },
    {
      "affiliations": [
        "Department of Hematology, Beijing Tongren Hospital CMU, Beijing, China"
      ],
      "name": "Jia Cong"
    },
    {
      "affiliations": [
        "Beijing Gobroad Boren Hospital, Beijing, China"
      ],
      "name": "Xiayu Xia"
    },
    {
      "affiliations": [
        "Department of Hematology, Beijing Tongren Hospital CMU, Beijing, China"
      ],
      "name": "Henan Wang"
    },
    {
      "affiliations": [
        "Beijing Gobroad Boren Hospital, Beijing, China"
      ],
      "name": "Xinjian Yu"
    },
    {
      "affiliations": [
        "Beijing Gobroad Boren Hospital, Beijing, China"
      ],
      "name": "Qinlong Zheng"
    },
    {
      "affiliations": [
        "Department of Hematology, Beijing Tongren Hospital CMU, Beijing, China"
      ],
      "name": "Liang Wang"
    }
  ],
  "title": "Secondary peripheral T-cell lymphoma in a patient with DLBCL harboring BLM mutation following CD19/CD22 bispecific CAR-T cell therapy",
  "uid": "4c2028c6-e095-5e0d-bd8a-b81362f1d8f8"
}