RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd
SP e001563
DO 10.1136/jitc-2020-001563
VO 8
IS 2
A1 George Mo
A1 Hao-Wei Wang
A1 Aimee C Talleur
A1 Shilpa A Shahani
A1 Bonnie Yates
A1 Haneen Shalabi
A1 Michael G Douvas
A1 Katherine R Calvo
A1 Jack F Shern
A1 Sridhar Chaganti
A1 Katharine Patrick
A1 Young Song
A1 Terry J Fry
A1 Xiaolin Wu
A1 Brandon M Triplett
A1 Javed Khan
A1 Rebecca A Gardner
A1 Nirali N Shah
YR 2020
UL http://jitc.bmj.com/content/8/2/e001563.abstract
AB 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.