T-cell Lymphoma and Secondary Primary Malignancy Risk After Commercial CAR T-cell Therapy.

We report a T-cell lymphoma (TCL) occurring three months after anti-CD19 chimeric antigen receptor (CAR) T-cell immunotherapy for non-Hodgkin B-cell lymphoma. The TCL was diagnosed from a thoracic lymph node upon surgery for lung cancer. The TCL exhibited CD8+ cytotoxic phenotype and a JAK3 variant, while the CAR transgene was very low. The T-cell clone was identified at low levels in the blood before CART infusion and in the lung cancer. To assess the overall risk of secondary primary malignancy (SPM) after commercial CART (CD19, BCMA), we analyzed 449 patients treated at the University of Pennsylvania. At a median follow-up of 10.3 months, 16 patients (3.6%) had SPM. Median onset time was 26.4 and 9.7 months for solid and hematological malignancies, respectively. The projected 5-year cumulative incidence is 15.2% for solid and 2.3% for hematological malignancies. Overall, one case of TCL was observed, suggesting a low risk of TCL post-CART.