TY - JOUR
T1 - CAR-T therapy in solid organ transplant recipients with treatment refractory posttransplant lymphoproliferative disorder
AU - Krishnamoorthy, Sambhavi
AU - Ghobadi, Armin
AU - Santos, Rowena D.
AU - Schilling, Joel D.
AU - Malone, Andrew F.
AU - Murad, Haris
AU - Bartlett, Nancy L.
AU - Alhamad, Tarek
N1 - Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/2
Y1 - 2021/2
N2 - Chimeric antigen receptor T cells (CAR-T) are genetically modified T cells with a chimeric antigen receptor directed against a specific tumor-associated antigen like CD19 in lymphoma. CAR-T cells have shown encouraging activity against recurrent and refractory diffuse large B cell lymphomas (DLBCL). However concurrent use of immunosuppressive agents was prohibited in most CAR-T trials effectively excluding patients with prior solid organ transplantation (SOT) and posttransplant lymphoproliferative disorders (PTLD). We report the outcomes for three patients with PTLD refractory to immunochemotherapy 10-20 years after SOT who received CAR-T therapy between January 2018 and December 2019. One patient had an orthotopic heart transplant, the second had a deceased donor kidney transplant, and the third had a pancreas after kidney transplant (PAK). All patients developed complications of CAR-T therapy such as cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, and acute kidney injury requiring renal replacement therapy in the two out of three patients. All patients expired after withdrawal of care due to lack of response to CAR-T therapy. In addition, the PAK patient developed acute pancreatitis after CAR-T therapy. This case series identifies the challenges of using CAR-T therapy to manage refractory PTLD in SOT recipients and its possible complications.
AB - Chimeric antigen receptor T cells (CAR-T) are genetically modified T cells with a chimeric antigen receptor directed against a specific tumor-associated antigen like CD19 in lymphoma. CAR-T cells have shown encouraging activity against recurrent and refractory diffuse large B cell lymphomas (DLBCL). However concurrent use of immunosuppressive agents was prohibited in most CAR-T trials effectively excluding patients with prior solid organ transplantation (SOT) and posttransplant lymphoproliferative disorders (PTLD). We report the outcomes for three patients with PTLD refractory to immunochemotherapy 10-20 years after SOT who received CAR-T therapy between January 2018 and December 2019. One patient had an orthotopic heart transplant, the second had a deceased donor kidney transplant, and the third had a pancreas after kidney transplant (PAK). All patients developed complications of CAR-T therapy such as cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, and acute kidney injury requiring renal replacement therapy in the two out of three patients. All patients expired after withdrawal of care due to lack of response to CAR-T therapy. In addition, the PAK patient developed acute pancreatitis after CAR-T therapy. This case series identifies the challenges of using CAR-T therapy to manage refractory PTLD in SOT recipients and its possible complications.
KW - bone marrow / hematopoietic stem cell transplantation
KW - clinical decision-making
KW - clinical research / practice
KW - complication: malignant
KW - hematology / oncology
KW - kidney failure / injury
KW - organ transplantation in general
KW - posttransplant lymphoproliferative disorder (PTLD)
UR - http://www.scopus.com/inward/record.url?scp=85097105358&partnerID=8YFLogxK
U2 - 10.1111/ajt.16367
DO - 10.1111/ajt.16367
M3 - Article
C2 - 33089906
AN - SCOPUS:85097105358
SN - 1600-6135
VL - 21
SP - 809
EP - 814
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 2
ER -