Real-world evidence of the safety and survival with CD19 CAR-T cell therapy for relapsed/refractory solid organ transplant-related PTLD

Marshall McKenna, Narendranath Epperla, Armin Ghobadi, Jieqi Liu, Aleksandr Lazaryan, Uroosa Ibrahim, Caron A. Jacobson, Seema G. Naik, Loretta Nastoupil, Sayan Mullick Chowdhury, Timothy J. Voorhees, Miriam T Jacobs, Umar Farooq, Keren Osman, Adam J. Olszewski, Sairah Ahmed, Andrew M. Evens

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

The use of CD19 chimeric antigen receptor T-cell (CAR-T) therapy for relapsed/refractory solid organ transplantation (SOT)-related post-transplant lymphoproliferative disorder (PTLD) is not well studied. We conducted a multicentre, retrospective analysis of adults with relapsed/refractory SOT-associated PTLD. Among 22 relapsed/refractory SOT-PTLD patients, the pathology was monomorphic B cell. Prior SOTs included 14 kidney (64%), three liver (14%), two heart (9%), one intestinal (5%), one lung (5%), and one pancreas after kidney transplant (5%). The median time from SOT to PTLD diagnosis was 107 months. Pre-CAR-T bridging therapy was used in 55% of patients, and immunosuppression was stopped completely before CAR-T infusion in 64%. Eighteen (82%) patients experienced cytokine release syndrome: one (5%) each grade (G) 3 and G4. The immune effector cell-associated neurotoxicity syndrome was observed in 16 (73%) patients: six (27%) G3 and two (9%) G4. The overall response rate was 64% (55% complete response). Three patients (14%) experienced allograft rejection after CAR-T. The two-year progression-free survival and overall survival rates were 35% and 58%, respectively. Additionally, the achievement of CR post-CAR-T was strongly associated with survival. Collectively, the safety and efficacy of CD19 CAR-T therapy in relapsed/refractory SOT-related PTLD appeared similar to pivotal CAR-T data, including approximately one-third of patients achieving sustained remission.

Original languageEnglish (US)
Pages (from-to)248-255
Number of pages8
JournalBritish Journal of Haematology
Volume202
Issue number2
DOIs
StatePublished - Jul 2023

All Science Journal Classification (ASJC) codes

  • Hematology

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