Clinical Scorecard: Acute Myeloid Leukemia Induced by Therapy with a 24-Month Latency Following CD19 CAR-T Cell Treatment for Relapsed/Refractory Diffuse Large B-Cell Lymphoma: A Case Study

At a Glance

Key Highlights

• Case of t-AML diagnosed 24 months post CD19 CAR-T therapy
• Transition from wild-type TP53 to biallelic loss of TP53 observed
• Patient achieved partial remission with azacitidine and venetoclax
• DLBCL remained in remission during AML-directed therapy
• Importance of ongoing hematologic monitoring emphasized

Guideline-Based Recommendations

Diagnosis

• Bone marrow examination and flow cytometry for abnormal myeloid blasts
• Genomic profiling to assess TP53 status

Management

• Consider azacitidine and venetoclax for treatment of t-AML
• Evaluate the need for allogeneic hematopoietic stem cell transplantation

Monitoring & Follow-up

• Longitudinal genomic monitoring post CAR-T therapy
• Hematologic monitoring beyond 12 months after CAR-T infusion

Risks

• Potential for therapy-related myeloid neoplasms following CAR-T therapy
• Increased risk of secondary malignancies due to prior treatments

Patient & Prescribing Data

65-year-old male with relapsed/refractory DLBCL

Combination therapy with azacitidine and venetoclax led to partial remission

Clinical Best Practices

• Perform baseline CHIP screening before CAR-T therapy
• Implement systematic longitudinal genomic profiling in patients post-CAR-T

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