--- title: International Journal Publication | Beijing GoBroad Boren Team Reports Long-Term Remission with Sequential Multi-Target CAR-T After Post-Transplant DLBCL Relapse url: "https://www.yyhmedical.com/en/news/car-t-sequential-therapy-allo-hsct-lymphoma-boren-team" type: Article inLanguage: en-US category: Medical Advances datePublished: 2026-01-30 --- # International Journal Publication | Beijing GoBroad Boren Team Reports Long-Term Remission with Sequential Multi-Target CAR-T After Post-Transplant DLBCL Relapse > A case report from the Beijing GoBroad Boren Hospital team, published in Frontiers in Immunology, describes long-term remission in a patient with relapsed/refractory DLBCL after allogeneic hematopoietic stem cell transplantation (allo-HSCT) following sequential CAR-T infusions targeting CD20, CD22 and CD19. Summary: A team led by Dr. Chunrong TONG at Beijing GoBroad Boren Hospital published a case report in Frontiers in Immunology describing a patient with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) after allo-HSCT who achieved long-term remission after sequential pseudoallogeneic CAR-T therapy targeting CD20, CD22 and CD19. The case suggests that a sequential, multi-target CAR-T strategy may help reduce relapse related to antigen escape and may offer a potential treatment approach for selected patients with complex post-transplant relapse. *Patients with refractory or relapsed diffuse large B-cell lymphoma (R/R DLBCL) generally have a poor prognosis. Reported median overall survival (OS) is about 6 months, with an overall response rate (ORR) of 26% and a complete remission (CR) rate of 7%. For patients with chemosensitive R/R DLBCL, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is commonly used as consolidation after salvage therapy. However, only around half of patients achieve durable remission after ASCT, and outcomes are poorer in aggressive subtypes such as activated B-cell-like (ABC) DLBCL, double-expressor lymphoma, and double- or triple-hit lymphoma (DHL/THL).* *CD19-targeted chimeric antigen receptor (CAR) T-cell therapy is another treatment option. Although CAR-T therapy can produce high complete remission rates, only about 30%-40% of patients achieve durable remission. Because relapse remains a concern after CAR-T, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is often considered as consolidation in acute B-cell lymphoblastic leukemia to help prolong remission.* Recently, the team led by Dr. Chunrong TONG at Beijing GoBroad Boren Hospital, together with Drs. Shaomei FENG, Qinlong ZHENG, Biping DENG, Zhihui LI and Defeng ZHAO, reported the case in Frontiers in Immunology under the title “Sequential pseudoallogeneic CAR20/22/19 T-cell therapy in patient with diffuse large B-cell lymphoma relapse after allo-HSCT: a case report.” The patient had relapsed despite multiple prior treatments, including immunochemotherapy, ASCT, radiotherapy, autologous CD19 CAR-T and allo-HSCT, and later received sequential pseudoallogeneic CAR-T cells targeting CD20, CD22 and CD19. The report suggests that this approach may be both feasible and effective in selected patients with DLBCL relapsing after allo-HSCT, and may help reduce relapse driven by antigen escape. ![30a6bee3-a6d4-40df-b75b-648b03f3bf84.png](https://gaobo-byh-h5.oss-accelerate.aliyuncs.com/images/20260914/c13204ab6adeb9ca55789e2b42ae29c1_20260914005812.png "c13204ab6adeb9ca55789e2b42ae29c1_20260914005812.png")Figure: The study was published in Frontiers in Immunology **Case Overview: Treatment History and Relapse** The patient was a 38-year-old woman diagnosed with DLBCL of the left breast in March 2018. After immunochemotherapy, ASCT and radiotherapy, she relapsed in May 2019 and was referred to our hospital. A peripheral blood smear showed an increased proportion of abnormal cells, with 36% classified as uncharacterized cells. These cells were slightly enlarged, with round, oval or irregular nuclei, abundant basophilic cytoplasm and visible nucleoli. Bone marrow examination showed active hematopoiesis with 71% abnormal lymphocytes, consistent with leukemic bone marrow involvement by lymphoma. ![30223cb6-6483-436e-a37c-9713440c2e8a.png](https://gaobo-byh-h5.oss-accelerate.aliyuncs.com/images/20260914/8c9d65a8b53e378aa4bef6543ce8c083_20260914005829.png "8c9d65a8b53e378aa4bef6543ce8c083_20260914005829.png")Figure: Clinical course of the patient Autologous CD19 CAR-T and allo-HSCT: After combination treatment with L-asparaginase, dexamethasone, vindesine and the BCL-2 inhibitor venetoclax, the tumor burden in peripheral blood decreased, with abnormal lymphocytes falling to 9%. Cerebrospinal fluid morphology and flow cytometry were both negative. In May 2019, the patient received lymphodepleting chemotherapy with fludarabine and cyclophosphamide (FC). Three days later, autologous CD19 CAR-T cells were infused at a total dose of 5 x 10^5/kg; CD3+ T cells accounted for 79.4% and CD3+ CAR T cells for 25.0%. After CAR-T infusion, the number of CAR-positive T cells continued to increase, peaking on day 14 and becoming undetectable by day 33 (see Table 1). Treatment was generally well tolerated. The patient developed only grade 1 cytokine release syndrome (CRS) and no immune effector cell-associated neurotoxicity syndrome (ICANS). At day 30 after CAR-T therapy, PET/CT showed complete remission (CR), and bone marrow and cerebrospinal fluid assessments remained negative. Peripheral blood genetic susceptibility testing identified variants in TLR5, CDKN2A and STK11. In July 2019, the patient underwent allo-HSCT using a reduced-intensity conditioning regimen of busulfan, fludarabine and antithymocyte globulin (BU/Flu/ATG). Peripheral blood stem cells from her older brother were infused. Neutrophil and platelet engraftment were achieved on days 16 and 14, respectively. Short-course methotrexate, cyclosporine and mycophenolate mofetil were used for graft-versus-host disease (GVHD) prophylaxis. The patient developed cutaneous GVHD during treatment, which improved after adjustment of immunosuppressive therapy. In January 2020, follow-up PET/CT showed new hypermetabolic nodules in both breasts, raising concern for lymphoma relapse. Biopsy of the left breast confirmed recurrent DLBCL. Bone marrow and cerebrospinal fluid remained negative. Cytogenetic analysis showed a donor karyotype, and bone marrow testing confirmed complete donor chimerism. **Sequential Pseudoallogeneic CAR-T Treatment** In March 2020, the patient received FC lymphodepletion. Three days later, she received the first pseudoallogeneic CD20 CAR-T infusion. The cells were collected from the allo-HSCT recipient and manufactured in-house, at a total dose of 1.6 x 10^5/kg; CD3+ T cells accounted for 82.7% and CD3+ CAR T cells for 9.75%. CAR-positive T cells expanded after infusion, peaked on day 13 and remained detectable through day 149 (see Table 1). Only grade 1 CRS occurred, with no ICANS. PET/CT at day 30 showed CR, while bone marrow and cerebrospinal fluid remained negative. ![655f4317-40ab-4906-b3ba-b3635b166f94.png](https://gaobo-byh-h5.oss-accelerate.aliyuncs.com/images/20260914/0cc64c81433092d445ced85782dd3bc8_20260914005905.png "0cc64c81433092d445ced85782dd3bc8_20260914005905.png") Table 1: Characteristics of the infused CAR-T cells To address heterogeneity in antigen expression and reduce the risk of relapse caused by antigen downregulation or loss, the patient subsequently received sequential pseudoallogeneic CD22 CAR-T cells in 2021 and CD19 CAR-T cells in 2022. The CD22 CAR-T dose was 1.16 x 10^4/kg, with CD3+ T cells accounting for 76.6% and CD3+ CAR T cells for 3.46%. The CD19 CAR-T dose was 3.23 x 10^4/kg, with CD3+ T cells accounting for 72.8% and CD3+ CAR T cells for 8.15% (Table 1). Both treatments were well tolerated, with no CRS or ICANS. The patient was discharged one week after each CAR-T infusion, so in-vivo CAR-T expansion was not monitored. At the time of this report, she had remained in complete remission for 5 years, with bone marrow morphology in CR, negative minimal residual disease, complete donor chimerism and no GVHD. The authors concluded that pseudoallogeneic CAR-T therapy may be safe and effective for selected patients with DLBCL who relapse after allo-HSCT. Sequential administration of CAR-T cells targeting CD20, CD22 and CD19 may help reduce relapse related to antigen escape. Larger clinical studies are still needed to confirm the safety and efficacy of this approach and to determine whether it can reliably reduce antigen-escape relapse in DLBCL after allo-HSCT. **Summary** This report describes the first case of long-term, sustained complete remission in a patient with R/R DLBCL after allo-HSCT treated with sequential pseudoallogeneic CAR-T cells targeting CD20, CD22 and CD19. The patient had relapsed despite multiple lines of therapy, including immunochemotherapy, ASCT, radiotherapy, autologous CD19 CAR-T and allo-HSCT. After sequential CD20-, CD22- and CD19-targeted pseudoallogeneic CAR-T infusions, she achieved durable complete remission, maintained for 5 years as reported in this article. Overall tolerability was favorable, with only low-grade CRS and no severe ICANS or GVHD. For the particularly challenging group of patients with R/R DLBCL relapsing after allo-HSCT, this case suggests that sequential, multi-target pseudoallogeneic CAR-T therapy may be a feasible salvage option. One possible advantage is broader antigen coverage, which may reduce the risk of relapse caused by antigen escape. Because this is a single case report, however, larger studies are needed before the approach can be generalized to other patients. --- Original (HTML):https://www.yyhmedical.com/en/news/car-t-sequential-therapy-allo-hsct-lymphoma-boren-team This is a clean Markdown mirror for large language models; the original page is authoritative.