ALL relapse after anti-CD19 CAR-T cells therapy in a young adult: which therapeutic options?
Résumé
T-cells expressing a Chimeric Antigen Receptor (CAR) recognizing the CD19 antigen allowed high early response rates in high-risk B acute lymphoblastic leukemias (B-ALL). Nevertheless, 35% to 44% of patients relapse. Among the mechanisms of immune evasion in CD19+ relapses of ALL, expression and secretion of molecules inhibiting cytotoxic T-lymphocytes, or lack of expression of co-stimulatory molecules, have been described. Expansion, persistence and cytotoxic activity of CAR-T cells could also be deficient.
Here, we present the case of a young adult who presented successive relapses of ALL after chemotherapy, hematopoietic stem cell transplant (HSCT) and anti-CD19 CAR-T cells. An extended immunophenotype of leukemic cells and sensitivity to anti-CD19 CAR-T cells mediated lysis are analysed.
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