GVHD after CAR T-cell therapy post allogeneic hematopoietic cell transplantation — successfully treated by extracorporeal photopheresis
IntroductionCAR T-cell therapy is highly effective, but also associated with unique toxicities. Because of the origin of T cells in patients who previously underwent allogeneic hematopoietic cell transplantation (alloHCT), graft-versus-host disease (GVHD) in the post-CAR T-cell setting poses a relev...
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Frontiers Media S.A.
2024-11-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1500177/full |
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| author | Kiavasch Mohammad Nejad Farid Gesine Bug Anita Schmitt Fabian Lang Maria-Luisa Schubert Uwe Haberkorn Carsten Müller-Tidow Peter Dreger Michael Schmitt |
| author_facet | Kiavasch Mohammad Nejad Farid Gesine Bug Anita Schmitt Fabian Lang Maria-Luisa Schubert Uwe Haberkorn Carsten Müller-Tidow Peter Dreger Michael Schmitt |
| author_sort | Kiavasch Mohammad Nejad Farid |
| collection | DOAJ |
| description | IntroductionCAR T-cell therapy is highly effective, but also associated with unique toxicities. Because of the origin of T cells in patients who previously underwent allogeneic hematopoietic cell transplantation (alloHCT), graft-versus-host disease (GVHD) in the post-CAR T-cell setting poses a relevant concern but is only scarcely studied. Potential risk factors and mitigation strategies (from CAR T-cell modifications to clinical management) are yet to be determined.MethodsSharing our retrospective experience and a mini-review of the literature, our aim is to better understand the frequency and risk of the potential occurrence of GVHD after CAR T cells, which are most likely underestimated. ResultsHere, we present a cohort of 11 patients with symptoms suggestive of GVHD out of 25 allografted patients treated with CAR T cells, of whom 3 patients (12%) had GVHD most likely triggered by the preceding CAR T-cell treatment. Severe chronic pulmonary GVHD occurred in a patient after CD19-directed CAR T-cell therapy. Extracorporeal photopheresis (ECP) mediated successful long-term control of GVHD without causing relapse of the underlying disease. Discussion/ConclusionIn conclusion, CD19-directed CAR T-cell therapy seems to be feasible in patients after alloHCT but might comprise the potential risk of triggering GVHD, most likely depending on the T-cell source, donor compatibility, and the specific CAR construct used. |
| format | Article |
| id | doaj-art-a3081d0d3e2a495586fae7c45402fb2f |
| institution | Kabale University |
| issn | 1664-3224 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj-art-a3081d0d3e2a495586fae7c45402fb2f2024-11-18T06:10:35ZengFrontiers Media S.A.Frontiers in Immunology1664-32242024-11-011510.3389/fimmu.2024.15001771500177GVHD after CAR T-cell therapy post allogeneic hematopoietic cell transplantation — successfully treated by extracorporeal photopheresisKiavasch Mohammad Nejad Farid0Gesine Bug1Anita Schmitt2Fabian Lang3Maria-Luisa Schubert4Uwe Haberkorn5Carsten Müller-Tidow6Peter Dreger7Michael Schmitt8Internal Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Medicine 2, Hematology and Oncology, Goethe University Frankfurt, University Hospital, Frankfurt, GermanyInternal Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Medicine 2, Hematology and Oncology, Goethe University Frankfurt, University Hospital, Frankfurt, GermanyInternal Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, GermanyInternal Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, GermanyInternal Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, GermanyInternal Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, GermanyIntroductionCAR T-cell therapy is highly effective, but also associated with unique toxicities. Because of the origin of T cells in patients who previously underwent allogeneic hematopoietic cell transplantation (alloHCT), graft-versus-host disease (GVHD) in the post-CAR T-cell setting poses a relevant concern but is only scarcely studied. Potential risk factors and mitigation strategies (from CAR T-cell modifications to clinical management) are yet to be determined.MethodsSharing our retrospective experience and a mini-review of the literature, our aim is to better understand the frequency and risk of the potential occurrence of GVHD after CAR T cells, which are most likely underestimated. ResultsHere, we present a cohort of 11 patients with symptoms suggestive of GVHD out of 25 allografted patients treated with CAR T cells, of whom 3 patients (12%) had GVHD most likely triggered by the preceding CAR T-cell treatment. Severe chronic pulmonary GVHD occurred in a patient after CD19-directed CAR T-cell therapy. Extracorporeal photopheresis (ECP) mediated successful long-term control of GVHD without causing relapse of the underlying disease. Discussion/ConclusionIn conclusion, CD19-directed CAR T-cell therapy seems to be feasible in patients after alloHCT but might comprise the potential risk of triggering GVHD, most likely depending on the T-cell source, donor compatibility, and the specific CAR construct used.https://www.frontiersin.org/articles/10.3389/fimmu.2024.1500177/fullgraft-versus-host diseaseCAR T-cell therapyextracorporeal photopheresisacute lymphoblastic leukemiaT-cell alloreactivity |
| spellingShingle | Kiavasch Mohammad Nejad Farid Gesine Bug Anita Schmitt Fabian Lang Maria-Luisa Schubert Uwe Haberkorn Carsten Müller-Tidow Peter Dreger Michael Schmitt GVHD after CAR T-cell therapy post allogeneic hematopoietic cell transplantation — successfully treated by extracorporeal photopheresis Frontiers in Immunology graft-versus-host disease CAR T-cell therapy extracorporeal photopheresis acute lymphoblastic leukemia T-cell alloreactivity |
| title | GVHD after CAR T-cell therapy post allogeneic hematopoietic cell transplantation — successfully treated by extracorporeal photopheresis |
| title_full | GVHD after CAR T-cell therapy post allogeneic hematopoietic cell transplantation — successfully treated by extracorporeal photopheresis |
| title_fullStr | GVHD after CAR T-cell therapy post allogeneic hematopoietic cell transplantation — successfully treated by extracorporeal photopheresis |
| title_full_unstemmed | GVHD after CAR T-cell therapy post allogeneic hematopoietic cell transplantation — successfully treated by extracorporeal photopheresis |
| title_short | GVHD after CAR T-cell therapy post allogeneic hematopoietic cell transplantation — successfully treated by extracorporeal photopheresis |
| title_sort | gvhd after car t cell therapy post allogeneic hematopoietic cell transplantation successfully treated by extracorporeal photopheresis |
| topic | graft-versus-host disease CAR T-cell therapy extracorporeal photopheresis acute lymphoblastic leukemia T-cell alloreactivity |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1500177/full |
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