TY - JOUR T1 - Diagnostic approach to the evaluation of myeloid malignancies following CAR T-cell therapy in B-cell acute lymphoblastic leukemia JF - Journal for ImmunoTherapy of Cancer JO - J Immunother Cancer DO - 10.1136/jitc-2020-001563 VL - 8 IS - 2 SP - e001563 AU - George Mo AU - Hao-Wei Wang AU - Aimee C Talleur AU - Shilpa A Shahani AU - Bonnie Yates AU - Haneen Shalabi AU - Michael G Douvas AU - Katherine R Calvo AU - Jack F Shern AU - Sridhar Chaganti AU - Katharine Patrick AU - Young Song AU - Terry J Fry AU - Xiaolin Wu AU - Brandon M Triplett AU - Javed Khan AU - Rebecca A Gardner AU - Nirali N Shah Y1 - 2020/11/01 UR - http://jitc.bmj.com/content/8/2/e001563.abstract N2 - Immunotherapeutic strategies targeting B-cell acute lymphoblastic leukemia (B-ALL) effectively induce remission; however, disease recurrence remains a challenge. Due to the potential for antigen loss, antigen diminution, lineage switch or development of a secondary or treatment-related malignancy, the phenotype and manifestation of subsequent leukemia may be elusive. We report on two patients with multiply relapsed/refractory B-ALL who, following chimeric antigen receptor T-cell therapy, developed myeloid malignancies. In the first case, a myeloid sarcoma developed in a patient with a history of myelodysplastic syndrome. In the second case, two distinct events occurred. The first event represented a donor-derived myelodysplastic syndrome with monosomy 7 in a patient with a prior hematopoietic stem cell transplantation. This patient went on to present with lineage switch of her original B-ALL to ambiguous lineage T/myeloid acute leukemia. With the rapidly evolving field of novel immunotherapeutic strategies, evaluation of relapse and/or subsequent neoplasms is becoming increasingly more complex. By virtue of these uniquely complex cases, we provide a framework for the evaluation of relapse or evolution of a subsequent malignancy following antigen-targeted immunotherapy. ER -