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Comment
. 2017 Nov 2;130(18):1961-1963.
doi: 10.1182/blood-2017-09-804070.

Anti-CD19 resistance can "stem" from progenitors

Nirali N Shah  1 , Terry J Fry  1
Affiliations
Comment

Anti-CD19 resistance can "stem" from progenitors

Nirali N Shah et al. Blood. .

Abstract

In this issue of Blood, Nagel et al provide evidence supporting the presence of premalignant leukemic clones in nonlymphoid compartments of patients with BCR-ABL1–positive B-cell precursor acute lymphoblastic leukemia (ALL) as a cause of lineage switch after CD19 immunotherapy, extending the lineage switch mechanism beyond mixed-lineage leukemia (MLL)-rearranged ALL. This observation suggests that CD19-targeted therapies alone may not suffice in the eradication of underlying disease in BCR-ABL1 p210- and p190-positive patients, and that strategies to target the stem cell compartment may be needed for durable remissions in this high-risk population.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Potential mechanism of relapse after CD19-targeted immunotherapy in patients with Ph+ ALL and BCR-ABL fusion in the CD19+ leukemic compartment, as well as multipotent progenitor (MPP) cells and/or other hematopeietic stem cell (HSC) progenitor compartments. With anti-CD19 immune pressure and eradication of CD19+ leukemia, CD19– myeloid phenotype leukemia can emerge, likely redifferentiated from the progenitor populations. Whether persistence of anti-CD19 pressure will increase the likelihood of this mechanism of resistance remains a question.
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Comment on

References

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