Rapid Progression of Therapy-Related Myelodysplastic Syndrome to AML After CAR-T

Overview

This case study presents a 76-year-old woman with refractory diffuse large B-cell lymphoma who developed therapy-related myelodysplastic syndrome (t-MDS) and subsequently progressed to acute myeloid leukemia (t-AML) following CAR-T cell therapy.

Background

Therapy-related myeloid neoplasms (t-MN), including t-MDS and t-AML, can arise after CAR-T cell therapy, particularly in patients with extensive prior treatment. Persistent cytopenia following CAR-T therapy may indicate these secondary malignancies.

Data Highlights

No numerical data or trial data presented in the article.

Key Findings

• A 76-year-old woman with refractory DLBCL developed persistent pancytopenia after CAR-T therapy.
• Bone marrow evaluation revealed multilineage dysplasia, 13% blasts, and TP53 deletion/mutation, leading to a diagnosis of t-MDS-LB.
• Within two months, the patient progressed to t-AML with 35% abnormal myeloid blasts.
• Combination therapy with azacitidine and venetoclax was initiated but discontinued due to severe myelosuppression and infection.
• Persistent post-CAR-T cytopenia can indicate an underlying t-MN.

Clinical Implications

Clinicians should be aware that persistent cytopenias following CAR-T therapy may signal the development of therapy-related myeloid neoplasms.

Conclusion

This case emphasizes the importance of monitoring for therapy-related myeloid neoplasms in patients experiencing prolonged cytopenias after CAR-T therapy.

Related Resources & Content

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2. The ASCO Post, 2013 -- Profound and Rapid Molecular Remission with CD19-targeted T Cells in Relapsed B-cell ALL
3. Blood Cancer Journal, 2023 -- Evaluation of the Safety and Effectiveness of CD22 and CD19 CAR-T Cell Therapy as a Bridging Strategy to Auto-Hematopoietic Stem Cell Transplantation for Adolescents and Young Adults with B-Cell Acute Lymphoblastic Leukemia
4. The ASCO Post, 2017 -- CAR T Cells in Relapsed B-Cell Acute Lymphoblastic Leukemia
5. Bone Marrow Transplantation, 2025 -- Less frequent complications following CAR T-cell therapies: hemophagocytic lymphohistiocytosis, graft-versus-host disease, thrombotic microangiopathy, coagulation disorders and secondary malignancies
6. Leukemia, 2025 -- Myeloid neoplasms after CD19-directed CAR T cells therapy in long-term B-cell lymphoma responders, a rising risk over time?
7. Less frequent complications following CAR T-cell therapies: hemophagocytic lymphohistiocytosis, graft-versus-host disease, thrombotic microangiopathy, coagulation disorders and secondary malignancies: best practice recommendations from the EBMT Practice Harmonization and Guidelines Committee | Bone Marrow Transplantation
8. Myeloid neoplasms after CD19-directed CAR T cells therapy in long-term B-cell lymphoma responders, a rising risk over time? | Leukemia