Lymphodepletion chemotherapy revitalizes chimeric antigen receptor T cells contributing to regression of relapsed B-cell lymphoma: A case report.

Abstract

INTRODUCTION:

Chimeric antigen receptor T cells (CAR-T) targeting CD19 have shown great potential for treatment of B-cell malignancies. For those patients who can not achieve complete remission (CR) or suffer from relapse after CAR-T therapy, further therapeutic strategies still remain elusive. Whether existing CAR-T cells can revitalize in vivo and eradicate tumor cells is still unknown.

PATIENT CONCERNS:

We report a case of diffused large B-cell lymphoma patient who had achieved CR after CD19 targeted CAR-T therapy but relapsed after 5 months.

DIAGNOSIS:

Five months after CAR-T cell infusion, the patient was confirmed a relapse by follow-up PET/CT scan and a mass biopsy. Flow cytometry showed a dramatically decreased percentage of CAR-T cells in peripheral blood (PB).

INTERVENTIONS:

A second anti-CD19 CAR-T therapy was planned with deliberation. Firstly, the patient received lymphodepletion chemotherapy with fludarabine (25 mg/m, d1-d3) and cyclophosphamide (500 mg/m d2-d3).

OUTCOMES:

After fludarabine and cyclophosphamide (FC) lymphodepletion chemotherapy, pre-existing CAR-T cells were revitalized and the patient developed grade 2 cytokine release syndrome (CRS) contributing to the regression of relapsed B-cell lymphoma.

CONCLUSIONS:

This case suggested that FC chemotherapy could revitalize CAR-T cells contributing to the regression of relapsed B-cell lymphoma. Nevertheless, further researches are required in the future as this report described only a single case.

• Authors: Zuyu Liang, Hao Zhang, Mi Shao, Qu Cui, Zhao Wu, Lei Xiao, He Huang, Yongxian Hu
• Journal: Medicine (Medicine (Baltimore)) Vol. 99 Issue 43 Pg. e22510 (Oct 23 2020) ISSN: 1536-5964 [Electronic] United States
• PMID: 33120740 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antigens, CD19
• Receptors, Chimeric Antigen
• Cyclophosphamide
• Vidarabine
• fludarabine

Topics

• Adult
• Antigens, CD19 (immunology)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cyclophosphamide (therapeutic use)
• Cytokine Release Syndrome (etiology)
• Humans
• Lymphocyte Depletion
• Lymphoma, Large B-Cell, Diffuse (drug therapy)
• Male
• Neoplasm Recurrence, Local (drug therapy)
• Receptors, Chimeric Antigen (immunology)
• Remission Induction
• T-Lymphocytes (immunology)
• Vidarabine (analogs & derivatives, therapeutic use)