Diagnostic approach to the evaluation of myeloid malignancies following CAR T-cell therapy in B-cell acute lymphoblastic leukemia.

Mo, George, Wang, Hao-Wei, Talleur, Aimee C, Shahani, Shilpa A, Yates, Bonnie, Shalabi, Haneen, Douvas, Michael G, Calvo, Katherine R, Shern, Jack F, Chaganti, Sridhar, Patrick, Katharine, Song, Young, Fry, Terry J, Wu, Xiaolin, Triplett, Brandon M, Khan, Javed, Gardner, Rebecca A and Shah, Nirali N (2020) Diagnostic approach to the evaluation of myeloid malignancies following CAR T-cell therapy in B-cell acute lymphoblastic leukemia. Journal for immunotherapy of cancer, 8 (2). ISSN 2051-1426. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://jitc.bmj.com/

Abstract

Immunotherapeutic strategies targeting B-cell acute lymphoblastic leukemia (B-ALL) effectively induce remission; however, disease recurrence remains a challenge. Due to the potential for antigen loss, antigen diminution, lineage switch or development of a secondary or treatment-related malignancy, the phenotype and manifestation of subsequent leukemia may be elusive. We report on two patients with multiply relapsed/refractory B-ALL who, following chimeric antigen receptor T-cell therapy, developed myeloid malignancies. In the first case, a myeloid sarcoma developed in a patient with a history of myelodysplastic syndrome. In the second case, two distinct events occurred. The first event represented a donor-derived myelodysplastic syndrome with monosomy 7 in a patient with a prior hematopoietic stem cell transplantation. This patient went on to present with lineage switch of her original B-ALL to ambiguous lineage T/myeloid acute leukemia. With the rapidly evolving field of novel immunotherapeutic strategies, evaluation of relapse and/or subsequent neoplasms is becoming increasingly more complex. By virtue of these uniquely complex cases, we provide a framework for the evaluation of relapse or evolution of a subsequent malignancy following antigen-targeted immunotherapy.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: QZ Pathology. Oncology
WH Haemic and lymphatic systems. Haematology
WS Paediatrics. Child health
Divisions: Planned IP Care > Oncology and Clinical Haematology
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Depositing User: Jamie Edgar
Date Deposited: 07 Dec 2020 13:58
Last Modified: 07 Dec 2020 13:58
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3756

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