CD19 CAR-T therapy in solid organ transplant recipients: case report and systematic review

• Published in: Bone marrow transplantation (Basingstoke) Vol. 58; no. 4; pp. 353 - 359
• Main Authors: Portuguese, Andrew J, Gauthier, Jordan, Tykodi, Scott S, Hall, Evan T, Hirayama, Alexandre V, Yeung, Cecilia C S, Blosser, Christopher D
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.04.2023
• Subjects: Antigens, CD19; B-cell lymphoma; Beta cells; Bone marrow; Burkitt's lymphoma; Case reports; CD19 antigen; Cell therapy; Death; Epstein-Barr Virus Infections; Failure analysis; Graft rejection; Humans; Immunotherapy, Adoptive - adverse effects; Kidney transplantation; Kidneys; Literature reviews; Lymphocytes; Lymphocytes T; Lymphoma; Lymphoma, Large B-Cell, Diffuse - pathology; Lymphoma, Large B-Cell, Diffuse - therapy; Lymphoproliferative Disorders - etiology; Lymphoproliferative Disorders - therapy; Neoplasm Recurrence, Local; Organ Transplantation - adverse effects; Pancreas transplantation; Posttransplant lymphoproliferative disorders; Receptors, Chimeric Antigen; Risk management; Stem cell transplantation; Therapy; Toxicity; Transplant Recipients
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/s41409-022-01907-z

Post-transplant lymphoproliferative disorder (PTLD) is a leading cause of cancer death in solid organ transplant recipients (SOTRs). Relapsed or refractory (R/R) PTLD portends a high risk of death and effective management is not well established. CD19-targeted CAR-T cell therapy has been utilized, but the risks and benefits are unknown. We report the first case of diffuse large B-cell lymphoma (DLBCL) PTLD treated with lisocabtagene maraleucel and present a systematic literature review of SOTRs with PTLD treated with CD19 CAR-T therapy. Our patient achieved a complete response (CR) with limited toxicity but experienced a CD19 relapse 8 months after infusion despite CAR-T persistence. Literature review revealed 14 DLBCL and 2 Burkitt lymphoma PTLD cases treated with CD19 CAR-T cells. Kidney (n = 12), liver (n = 2), heart (n = 2), and pancreas after kidney (n = 1) transplant recipients were analyzed. The objective response rate (ORR) was 82.4% (14/17), with 58.5% (10/17) CRs and a 6.5-month median duration of response. Among kidney transplant recipients, the ORR was 91.7% (11/12). Allograft rejection occurred in 23.5% (4/17). No graft failure occurred. Our analysis suggests that CD19 CAR-T therapy offers short-term effectiveness and manageable toxicity in SOTRs with R/R PTLD. Further investigation through larger datasets and prospective study is needed.