Therapy-related myelodysplastic syndrome rapidly evolving to acute myeloid leukemia following CAR-T cell therapy in a patient with refractory diffuse large B-cell lymphoma: a case report

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Persistent cytopenia after CAR-T therapy can indicate therapy-related myeloid neoplasms rather than just transient hematotoxicity.
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A 76-year-old woman with refractory DLBCL developed therapy-related myelodysplastic syndrome, progressing to acute myeloid leukemia within two months.
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Bone marrow evaluation revealed multilineage dysplasia, 13% blasts, and TP53 alterations, confirming the diagnosis of therapy-related myelodysplastic syndrome.
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Combination therapy with azacitidine and venetoclax was initiated for the patient's acute myeloid leukemia but was discontinued due to severe complications.
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Vigilant bone marrow surveillance is crucial for patients with extensive prior cytotoxic treatment to prevent diagnostic delays in myeloid neoplasms.

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