Relapse After Chemotherapy, Then Again After CAR-T: A Young Man Reaches Five Years in Remission After CD22 CAR-T and Transplant

Summary: At 17, Yangyang (pseudonym) should have been focused on school and the future. Instead, he was diagnosed with B-cell acute lymphoblastic leukemia (B-ALL). He achieved remission with chemotherapy but later relapsed, and then relapsed again after CD19 CAR-T therapy. In 2021, he and his mother traveled to Beijing GoBroad Boren Hospital. Given his high-risk disease, including an E2A-PBX1 fusion and multiple relapses, the teams led by Dr. Tong WU and Dr. Yanzhi SONG developed an integrated treatment plan using CD22 CAR-T therapy as a bridge to a related-donor haploidentical hematopoietic stem cell transplant. Yangyang ultimately achieved long-term remission. Now, five years after transplant, his bone marrow remains in complete remission, donor chimerism remains fully donor-derived, and he has returned to university to continue the life that illness once interrupted.

At 17, Yangyang, from Sichuan, should have been studying in the classroom and running across the school field. Instead, he was diagnosed with B-cell acute lymphoblastic leukemia. He relapsed after achieving remission with chemotherapy and then relapsed again after CAR-T immunotherapy, leaving his family with few options. In early 2021, after searching widely for help, Yangyang and his mother traveled to Beijing GoBroad Boren Hospital. Taking into account his E2A-PBX1 fusion-positive disease and history of multiple relapses, the teams led by Dr. Tong WU and Dr. Yanzhi SONG developed a personalized plan using CAR-T therapy as a bridge to a related-donor haploidentical hematopoietic stem cell transplant, with his father as the donor.

Today, at 22, Yangyang has reached the important five-year post-transplant milestone. His bone marrow remains in complete remission, donor chimerism remains fully donor-derived, and his overall results are stable. The teenager who stayed optimistic even at the hardest moments is now a second-year university student. He still has the same warm smile, but with a calmness that comes from everything he has been through. His story carries a simple message: when you choose not to give up, a way forward can still appear.

Photo from Yangyang's five-year post-transplant follow-up

From Over 75 kg to 54 kg: An Unexpected Health Crisis at 17

At the beginning of 2020, I was in my first year of high school. At some point, I started feeling exhausted all the time and lost my appetite. My weight dropped from more than 75 kg to about 54 kg. I became so thin that even my pajamas hung loosely on me. I went to the hospital twice because of weakness and joint swelling after eating seafood. But I had always been healthy, had never been hospitalized, and did not even know what an IV infusion felt like, so I did not think much of it.

Then one morning in February 2020, I was getting ready for breakfast when my nose started itching. I scratched it casually and suddenly began bleeding. The blood looked unusually thin and watery rather than the normal thick, bright red. My mother's expression changed immediately, and she rushed me to the emergency department.

I underwent a full evaluation at a local hospital in Sichuan. My blood count showed a hemoglobin level of just 53 g/L and a platelet count of only 15 x 10^9/L. A bone marrow examination found that blasts accounted for 65% of the cells. I was diagnosed with acute lymphoblastic leukemia, common B-ALL, with an E2A-PBX1 fusion.

My family worried that I would not be able to handle the truth, so they did not tell me exactly what the diagnosis was. I did not ask many questions either. All I wanted was to get better and go back to school. Looking back now, I had no idea how difficult the road ahead would become.

Relapse After Relapse: Running Out of Options

After diagnosis, I began a long course of treatment. I first received VDCLP induction chemotherapy. At the end of treatment, my bone marrow showed morphologic remission, flow cytometry was negative, and the E2A-PBX1 fusion became undetectable. I then completed Hyper-CVAD A consolidation chemotherapy and went home to recover as instructed. I was so happy at the time and thought the illness was finally behind me.

Only about two weeks later, a repeat bone marrow examination showed that blasts had risen to 94%. My mother wanted to take me to a major tertiary hospital in Sichuan, but there were no beds available and we could not afford to wait. We transferred to a hospital in Xi'an for further treatment. After FC chemotherapy, my bone marrow morphology improved, but flow-cytometric MRD remained positive, the E2A-PBX1 fusion remained detectable, and a new PAX5 mutation was also identified.

In July 2020, another bone marrow examination showed that blasts had risen again to 81.5%. My treating physician promptly arranged an infusion of CD19 CAR-T cells. Assessments on days 17 and 30 after CAR-T showed sustained bone marrow remission, and both E2A-PBX1 and PAX5 became undetectable. Once my condition stabilized, I even returned to school briefly and completed part of a semester.

Around that time, on the way to a follow-up visit, my mother carefully asked me, "Have you ever wondered what illness you actually have?" When she saw that I was calm, she told me the truth. Strangely, knowing the diagnosis made me feel less burdened. I have always been someone who does not swing too far between highs and lows. I also feel that the better your mindset, the easier it is to focus on recovery. The more you avoid talking about the illness, the more it can feel like a weight pressing down on you.

Unfortunately, the remission did not last. In January 2021, PET-CT showed extramedullary disease. After repeated relapses and increasingly difficult-to-control leukemia, the local hospital had no effective options left to offer. Once again, we had to look elsewhere for a way forward.

Traveling to Beijing: CD22 CAR-T as a Bridge to Transplant

Even then, my mother refused to give up. She kept asking around and learned that Beijing GoBroad Boren Hospital had extensive experience treating refractory and relapsed leukemia. Chinese New Year was approaching, but she did not want treatment to be delayed, so she took me to Beijing as soon as possible.

We arrived at Beijing GoBroad Boren Hospital on January 28, 2021. A comprehensive evaluation showed morphologic bone marrow remission and negative flow cytometry, but the E2A-PBX1 fusion was still detectable at 0.022%. The teams led by Dr. Tong WU and Dr. Yanzhi SONG quickly developed a treatment plan. Given my young age and history of multiple relapses, they recommended CAR-T therapy followed by transplantation as the best next step.

On February 10, I received CD22 CAR-T cells. Follow-up evaluations at two weeks and one month showed remission by both bone marrow assessment and flow cytometry, and the fusion gene finally became undetectable. PET-CT also showed that the lesions had shrunk substantially and their metabolic activity had fallen markedly. After reviewing everything together, however, the team felt that a small risk of residual disease remained. Dr. Yanzhi SONG spoke with my mother in detail about the next phase of treatment.

The transplant teams led by Dr. Tong WU and Dr. Yanzhi SONG then designed an individualized transplant plan for me. On March 24, 2021, I began an intensified conditioning regimen with TBI/Ara-C/VP-16/FLU/ATG. On April 6, I received my father's bone marrow, followed by peripheral blood stem cell infusions over the next two days.

Before I entered the transplant unit, I really had no idea what transplantation would be like. I have always thought of myself as an optimistic person, but being alone in a closed protective-isolation room could still make me feel low and irritable. Eventually I developed a routine: every afternoon at around two or three, I would take a nap. When I woke up, I usually felt calmer again.

When I had free time, I would play online games with friends. But they still had school and their own lives, so they could not always be there. The loneliness could be intense. I knew, though, that this was one part of the journey I had to get through myself.

During transplant, I developed severe mouth ulcers, my platelet count was slow to recover, and steroids caused noticeable facial swelling. It was a difficult period. Fortunately, engraftment went relatively smoothly: my platelets engrafted on day +11 and my white blood cells on day +16. Compared with what some other patients went through, I felt I had been fortunate. The day I left protective isolation and breathed the air outside again, I felt as though I had finally come back to life.

At my one-month post-transplant evaluation, the results were reassuring: both bone marrow and cerebrospinal fluid were in complete remission, and chimerism had become fully donor-derived. I soon met the criteria for discharge and went home to continue recovering.

As my health steadily improved, I finally returned to school a little over a year after transplant. I went on to finish high school and was admitted to university, where I wanted to learn a practical skill and build my future step by step.

The five years after transplant were not completely smooth. My white blood cell and platelet counts sometimes dropped again, and my blood pressure fluctuated frequently. Fortunately, Dr. Tong WU and Dr. Yanzhi SONG continued to follow me closely. With their clinical experience, they evaluated each new problem carefully and adjusted my care as needed, helping me through one recovery challenge after another. The hardest setback for me came about two years after transplant, when I developed avascular necrosis of the right femoral head. Before I became ill, I loved playing table tennis and could move quickly around the table. Afterward, walking too much made my leg feel so heavy that it was hard to lift. By following the medical team's advice, resting when needed, and taking care of the joint over the long term, the discomfort gradually improved. I now have very little pain and can manage normal daily activities without difficulty.

Since becoming ill, I have never felt an overwhelming emotional burden about the diagnosis. When friends ask, I do not try to hide it. They know I am generally optimistic and they treat it matter-of-factly, which actually makes me feel more comfortable.

Going through all of this also helped me change some careless habits from when I was younger. My parents used to run a restaurant, and I would help out. As a reward, they let me have one bottle of soda a day. I remember lying in bed at night happily wondering whether I would choose Coke or Sprite the next day. I still buy a bottle once in a while as a treat, and I still enjoy it, but now I automatically remind myself not to overdo things the way I used to.

Gratitude and a New Beginning: The Things I Never Said Out Loud

Looking back over these five years, there is so much I could say. But the first thing I want to tell my mother is simply: Mom, I'm sorry.

There was a period during treatment when I became very irritable and would lose my temper for no reason. I did not really notice how much I had changed, but my mother did. I have always felt that I owed her that apology.

I also want to thank my father. While my mother stayed with me in Beijing for treatment, he remained back home, working from early morning until late at night to earn money for my care, while carrying the worry about my condition largely on his own. It is hard to imagine how much pressure he was under.

And of course, I want to thank the medical team at Beijing GoBroad Boren Hospital. Dr. Tong WU, Dr. Yanzhi SONG, and all the nurses who looked after me every day gave me hope through their expertise, patience, and constant care. I still remember the day I finished my five-year follow-up. My attending physician, Dr. Erhui YUAN, smiled and said, "You won't need to keep coming back like this anymore." In that moment, all the difficult days and all the persistence suddenly felt worth it. I felt relieved, fortunate, and deeply grateful all at once.

If someone asks me how I got through all of this, I would say that mindset really matters. I knew another patient who became completely discouraged after learning about the diagnosis, stopped following medical advice, secretly ordered takeout, and ignored dietary precautions. The disease later relapsed, which was heartbreaking. I have always felt that we cannot choose whether illness happens to us, but we can choose how we respond to it. If we give up on ourselves, even the best doctors and the best treatment plans can only do so much.

Five years have passed since my transplant almost before I realized it. At this latest follow-up, my results remained stable and the leukemia was still in complete remission. I am now back at university, studying steadily and trying to make the most of each day. For me, an ordinary, peaceful life like this is the best kind of life. I hope my story can offer even a small amount of light and strength to someone who is still trying to find a way through the dark. Do not give up. The night can feel darkest just before dawn, but if you keep going, morning will come.