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Successful chimeric antigen receptor T cells therapy in extramedullary relapses of acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 55, pages 1476–1478 (2020)Cite this article

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment for patients with acute leukemia. However, leukemia relapse after HSCT remains the major cause of treatment failure. Depending on the site of leukemia recurrence, relapse can be categorized into bone marrow relapse and extramedullary relapse (EMR). EMR has been observed frequently after allo-HSCT with the incidence of 5–20%, especially in acute lymphoblastic leukemia (ALL), which reaches 29.3% [1]. EMR in ALL has been observed in extremely diverse site, with or without bone marrow involvement [2]. Isolated EMR often results in systemic relapse, and when BM and EM relapse occurs synchronously, survival is very poor [3]. There is still no standard treatment for EMR after allo-HSCT, despite the practices of systemic chemotherapy, local radiotherapy, donor lymphocyte infusion (DLI), second transplantation or combination of these strategies. The effectiveness of treatment strategies mentioned above remains controversial which posed therapeutic dilemmas. Therefore, development of novel approach is urgently needed.

Chimeric antigen receptor T cells (CART) targeting CD19 demonstrated remarkable efficacy in treatment of CD19 positive hematologic malignancies in recent years. The most impressive responses have been achieved in patients with refractory or relapsed B-ALL with the complete remission (CR) rate reaching 90% [4]. Whereas the efficacy and safety of CART cells on EMR after allo-HSCT still needs to be clarified. Here we report that two cases of patients with ALL who experienced extramedullary breast and bone tissue relapse respectively after allo-HSCT successfully treated by CD19 targeted CART cells.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (81230014, 81470341, 81520108002, 81500157), Key Project of Science and Technology Department of Zhejiang Province (2018C03016-2), Zhejiang Provincial Natural Science Foundation of China (LY16H80003).

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  1. These authors contribute equally: Hao Zhang, Yongxian Hu

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  1. Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

    Hao Zhang, Yongxian Hu, Guoqing Wei, Wenjun Wu & He Huang

  2. Institute of Hematology, Zhejiang University, Hangzhou, China

    He Huang

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Correspondence to He Huang.

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Zhang, H., Hu, Y., Wei, G. et al. Successful chimeric antigen receptor T cells therapy in extramedullary relapses of acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 55, 1476–1478 (2020). https://doi.org/10.1038/s41409-019-0778-8

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