{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:05:52Z","timestamp":1784005552738,"version":"3.55.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent cytopenia following chimeric antigen receptor T-cell (CAR-T) therapy is an increasingly recognized complication in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). While most cases stem from transient, immune-mediated mechanisms or depleted bone marrow reserves, secondary therapy-related myeloid neoplasms (t-MN) must be strongly suspected in patients presenting with prolonged, transfusion-refractory cytopenias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We report the case of a 76-year-old woman diagnosed with refractory DLBCL (non-germinal center B-cell subtype, stage IIIA, International Prognostic Index score of 4). Following multiple lines of chemo-immunotherapy (R-CDOP, R-CDOPE, R-ICE, local radiotherapy, and one cycle of Pola-R-ICE) and subsequent autologous CAR-T cell infusion, the patient developed persistent pancytopenia, characterized by severe, transfusion-refractory thrombocytopenia. A comprehensive bone marrow evaluation performed in February 2026 revealed multilineage dysplasia, 13% blasts,\n                      <jats:italic>TP53<\/jats:italic>\n                      deletion\/mutation, and a complex karyotype, establishing a diagnosis of therapy-related myelodysplastic syndrome with low blasts (t-MDS-LB). Within two months, the disease rapidly progressed to acute myeloid leukemia (t-AML) with 35% abnormal myeloid blasts. Combination therapy with azacitidine and venetoclax was initiated but discontinued due to profound myelosuppression and severe infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores that persistent post-CAR-T cytopenia can serve as an early manifestation of an underlying t-MN rather than transient hematotoxicity. Prompt and comprehensive bone marrow assessments\u2014incorporating morphology, flow cytometry, cytogenetics, and molecular profiling\u2014are paramount for patients with extensive prior exposure to cytotoxic regimens to avoid catastrophic diagnostic delays.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1888595","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:22:28Z","timestamp":1784002948000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapy-related myelodysplastic syndrome rapidly evolving to acute myeloid leukemia following CAR-T cell therapy in a patient with refractory diffuse large B-cell lymphoma: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Longmei","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine (Baoshan Hospital, Shanghai University of Traditional Chinese Medicine)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanchao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine (Baoshan Hospital, Shanghai University of Traditional Chinese Medicine)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1038\/s41389-026-00629-x","article-title":"Metabolic vulnerabilities and therapeutic opportunities in diffuse large B-cell lymphoma","volume":"15","author":"Neumann","year":"2026","journal-title":"Oncogenesis"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31366-0","article-title":"Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): A multicentre seamless design study","volume":"396","author":"Abramson","year":"2020","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/jha2.70282","article-title":"Durable remission of highly refractory multiple myeloma and therapy\u2010related MDS\/AML after allogeneic hematopoietic cell transplantation: Reconsidering its role in the CAR\u2010T era","volume":"7","author":"Kumamoto","year":"2026","journal-title":"EJHaem"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1036455","article-title":"High risk-myelodysplastic syndrome following CAR T-cell therapy in a patient with relapsed diffuse large B cell lymphoma: A case report and literature review","volume":"13","author":"Accorsi Buttini","year":"2023","journal-title":"Front Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.44677","article-title":"Myelodysplastic syndrome 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therapy-related AML","volume":"15","author":"Kotsiafti","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-025-06310-4","article-title":"Therapy related acute myeloid leukemia secondary to CAR-T therapy in refractory\/relapsed multiple myeloma patient showing poor prognosis","volume":"104","author":"An","year":"2025","journal-title":"Ann Hematol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020010543","article-title":"CAR-HEMATOTOX: a model for CAR T-cell\u2013related hematologic toxicity in relapsed\/refractory large B-cell lymphoma","volume":"138","author":"Rejeski","year":"2021","journal-title":"Blood"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2022.103607","article-title":"Diagnosis and treatment of therapy-related acute myeloid leukemia","volume":"171","author":"Strickland","year":"2022","journal-title":"Crit Rev Oncol\/Hematol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3390\/lymphatics4020021","article-title":"Treatment-related myelodysplastic syndrome and acute myeloid leukemia associated with CAR T-cell therapies: A real-world FAERS pharmacovigilance study","volume":"4","author":"Frey","year":"2026","journal-title":"Lymphatics"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.1063986","article-title":"Secondary myeloid neoplasms after CD19 CAR T therapy in patients with refractory\/relapsed B-cell lymphoma: Case series and review of literature","volume":"13","author":"Zhao","year":"2023","journal-title":"Front Immunol"}],"container-title":["Frontiers in 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