• Blood · May 2016

    Case Reports

    Acquisition of a CD19-negative myeloid phenotype allows immune escape of MLL-rearranged B-ALL from CD19 CAR-T-cell therapy.

    • Rebecca Gardner, David Wu, Sindhu Cherian, Min Fang, Laïla-Aïcha Hanafi, Olivia Finney, Hannah Smithers, Michael C Jensen, Stanley R Riddell, David G Maloney, and Cameron J Turtle.
    • Seattle Children's Research Institute, Department of Pediatrics, and.
    • Blood. 2016 May 19; 127 (20): 2406-10.

    AbstractAdministration of lymphodepletion chemotherapy followed by CD19-specific chimeric antigen receptor (CAR)-modified T cells is a remarkably effective approach to treating patients with relapsed and refractory CD19(+) B-cell malignancies. We treated 7 patients with B-cell acute lymphoblastic leukemia (B-ALL) harboring rearrangement of the mixed lineage leukemia (MLL) gene with CD19 CAR-T cells. All patients achieved complete remission (CR) in the bone marrow by flow cytometry after CD19 CAR-T-cell therapy; however, within 1 month of CAR-T-cell infusion, 2 of the patients developed acute myeloid leukemia (AML) that was clonally related to their B-ALL, a novel mechanism of CD19-negative immune escape. These reports have implications for the management of patients with relapsed and refractory MLL-B-ALL who receive CD19 CAR-T-cell therapy.© 2016 by The American Society of Hematology.

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