A 29-year-old male had fever, splenomegaly, and bone pain….A plasma cell-free DNA [cfDNA] next-generation sequencing assay detected the ALK I1171N mutation that confers resistance to alectinib but is sensitive to lorlatinib. On day +152, plasma cfDNA genotyping showed no ALK mutation. Bone marrow biopsy showed no lymphoma and negative ALK mutation analysis. The patient is tolerating lorlatinib well.