{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:22:02Z","timestamp":1793330522897,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2025ZD0544300"],"award-info":[{"award-number":["2025ZD0544300"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2026,6,24]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>\n                    We describe a case of secondary peripheral T-cell lymphoma (PTCL) arising from infused CD19\/CD22-4-1BB-CD3\u03b6-lenti bispecific chimeric antigen receptor (CAR)-T cells in a patient with relapsed or refractory B-cell lymphoma who carried a pathogenic germline\n                    <jats:italic>BLM<\/jats:italic>\n                    p.L107Ffs*36 variant. Integrated genomic and molecular analyses confirmed that the PTCL was clonally derived from the infused CAR-T product and revealed a multistep oncogenic process involving pre-existing driver mutations (\n                    <jats:italic>BLM<\/jats:italic>\n                    ), somatic\n                    <jats:italic>TET2<\/jats:italic>\n                    mutations (p.R1261H and p.E1755*), and genomic instability. Clonal CAR vector integration events in cancer-associated genes (\n                    <jats:italic>NF1, CBX5, RNF213,<\/jats:italic>\n                    etc) were identified as markers of clonal expansion, although no functional evidence supports a direct oncogenic role. We acknowledge that this case lies on a spectrum between clonal lymphoproliferative disorder and overt PTCL, and terminology continues to evolve. This case suggests a need for re-biopsy of suspected relapses after CAR-T therapy and highlights the limitations of conventional product assessment in detecting premalignant clones.\n                  <\/jats:p>","DOI":"10.1136\/jitc-2026-014873","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T13:45:18Z","timestamp":1783518318000},"page":"e014873","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Secondary peripheral T-cell lymphoma in a patient with DLBCL harboring\n                    <i>BLM<\/i>\n                    mutation following CD19\/CD22 bispecific CAR-T cell therapy"],"prefix":"10.1136","volume":"14","author":[{"given":"Xindi","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Hematology, Beijing Tongren Hospital CMU, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Cong","sequence":"additional","affiliation":[{"name":"Department of Hematology, Beijing Tongren Hospital CMU, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiayu","family":"Xia","sequence":"additional","affiliation":[{"name":"Beijing Gobroad Boren Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology, Beijing Tongren Hospital CMU, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinjian","family":"Yu","sequence":"additional","affiliation":[{"name":"Beijing Gobroad Boren Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinlong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Beijing Gobroad Boren Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6140-914X","authenticated-orcid":false,"given":"Liang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology, Beijing Tongren Hospital CMU, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"2026090205002560000_14.7.e014873.1","unstructured":"Research, C. for B. E. and. FDA Investigating Serious Risk of T-cell Malignancy Following BCMA-Directed or CD19-Directed Autologous Chimeric Antigen Receptor (CAR) T cell Immunotherapies. FDA; 2023. Available: https:\/\/www.fda.gov\/vaccines-blood-biologics\/safety-availability-biologics\/fda-investigating-serious-risk-t-cell-malignancy-following-bcma-directed-or-cd19-directed-autologous"},{"key":"2026090205002560000_14.7.e014873.2","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1007\/s12185-025-04074-1","article-title":"Peripheral T cell lymphoma following CD19-targeted chimeric antigen receptor T cell therapy","volume":"122","author":"Tatetsu","year":"2025","journal-title":"Int J Hematol"},{"key":"2026090205002560000_14.7.e014873.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2402730"},{"key":"2026090205002560000_14.7.e014873.4","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1038\/s41591-024-03458-w","article-title":"T cell malignancies after CAR T\u2009cell therapy in the DESCAR-T registry","volume":"31","author":"Dulery","year":"2025","journal-title":"Nat 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