Indolent CD4+ CAR T-Cell Lymphoma after Cilta-cel CAR T-Cell Therapy

N Engl J Med. 2024 Jun 13;390(22):2074-2082. doi: 10.1056/NEJMoa2401530.


Indolent CD4+ cytotoxic chimeric antigen receptor (CAR) T-cell lymphoma involving the small intestine was diagnosed in a patient who had previously received ciltacabtagene autoleucel (cilta-cel) CAR T-cell therapy for treatment of myeloma. Targeted messenger RNA sequencing revealed the presence of CAR gene product in tumor cells. Whole-genome sequencing of samples of tumor and peripheral blood identified a single lentiviral insertion site within the second intron of the SSU72 gene. In addition, numerous genetic alterations that may have contributed to malignant transformation were identified in the tumor sample. (Funded by MedStar Georgetown University Hospital.).

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents, Immunological* / adverse effects
  • Antineoplastic Agents, Immunological* / therapeutic use
  • Biological Products / administration & dosage
  • Biological Products / therapeutic use
  • CD4-Positive T-Lymphocytes* / immunology
  • Humans
  • Immunotherapy, Adoptive* / adverse effects
  • Immunotherapy, Adoptive* / methods
  • Lymphoma, T-Cell* / etiology
  • Lymphoma, T-Cell* / genetics
  • Lymphoma, T-Cell* / immunology
  • Lymphoma, T-Cell* / therapy
  • Male
  • Middle Aged
  • Multiple Myeloma / genetics
  • Multiple Myeloma / immunology
  • Multiple Myeloma / therapy
  • Receptors, Antigen, T-Cell / genetics
  • Receptors, Antigen, T-Cell / therapeutic use
  • Receptors, Chimeric Antigen* / immunology
  • Receptors, Chimeric Antigen* / therapeutic use


  • axicabtagene ciloleucel
  • Biological Products
  • Receptors, Antigen, T-Cell
  • Receptors, Chimeric Antigen
  • Antineoplastic Agents, Immunological