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. 2021 Feb;21(2):809-814.
doi: 10.1111/ajt.16367. Epub 2020 Dec 5.

CAR-T therapy in solid organ transplant recipients with treatment refractory posttransplant lymphoproliferative disorder

Sambhavi Krishnamoorthy  1 , Armin Ghobadi  2 , Rowena D Santos  1 , Joel D Schilling  3   4 , Andrew F Malone  1 , Haris Murad  1 , Nancy L Bartlett  2 , Tarek Alhamad  1   5
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Free article

CAR-T therapy in solid organ transplant recipients with treatment refractory posttransplant lymphoproliferative disorder

Sambhavi Krishnamoorthy et al. Am J Transplant. 2021 Feb.
Free article

Abstract

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.

Keywords: bone marrow / hematopoietic stem cell transplantation; clinical decision-making; clinical research / practice; complication: malignant; hematology / oncology; kidney failure / injury; organ transplantation in general; posttransplant lymphoproliferative disorder (PTLD).

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References

REFERENCES

    1. Dierickx D, Habermann TM. Post-transplantation lymphoproliferative disorders in adults. N Engl J Med. 2018;378(6):549-562.
    1. Dharnidharka VR, Webster AC, Martinez OM, Preiksaitis JK, Leblond V, Choquet S. Post-transplant lymphoproliferative disorders. Nat Rev Dis Primers. 2016;2(1):1-20.
    1. Peters AC, Akinwumi MS, Cervera C, et al. The changing epidemiology of posttransplant lymphoproliferative disorder in adult solid organ transplant recipients over 30 years: a single-center experience. Transplantation. 2018;102(9):1553-1562.
    1. Trappe RU, Dierickx D, Zimmermann H, et al. Response to rituximab induction is a predictive marker in B-cell post-transplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international, prospective, multicenter phase II trial. J Clin Oncol. 2017;35(5):536-543.
    1. Elstrom RL, Andreadis C, Aqui NA, et al. Treatment of PTLD with rituximab or chemotherapy. Am J Transplant. 2006;6(3):569-576.

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