Pediatric Acute Lymphoblastic Leukemia Extramedullary Relapse Responds to CAR-T

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CAR-T immunotherapy can induce objective responses in pediatric patients with extramedullary relapse of CD19+ ALL.
CAR-T immunotherapy can induce objective responses in pediatric patients with extramedullary relapse of CD19+ ALL.
The following article features coverage from the 2017 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois. Click here to read more of Oncology Nurse Advisor's conference coverage. 

CHICAGO — Chimeric antigen receptor-modified T (CAR-T) immunotherapy can induce potent and durable responses in pediatric patients with extramedullary relapse of CD19+ acute lymphoblastic leukemia (ALL), according to study findings presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.

Mala Kiran Talekar, MD, of the Cancer Immunotherapy Program at The Children's Hospital of Philadelphia, and colleagues studied 10 patients with CD19+ ALL who had extramedullary (EM) involvement on average 2.3 months (range 0 to 9 months) prior to CAR-T cell infusion. Five patients had EM disease at the time of infusion. Sites of EM relapse included testes, sinus, parotid, bone, uterus, kidney, and skin. Five patients had multiple sites of EM involvement.

All 10 patients had undergone hematopoietic stem cell transplantation prior to EM relapse; 2 were treated with radiation directed to the EM site prior to CAR-T.

Five patients evaluated by serial imaging had objective responses. Two had resolution of EM disease by day 28; 2 had resolution by 3 months; and 1 had continued decrease in size of a uterine mass at 3 and 6 months and underwent hysterectomy at 8 months, with no evidence of disease on pathology. In the 4 patients with a prior history of skin or testicular involvement, there was no evidence of this by examination at day 28. One patient experienced progressive EM disease within 2 weeks of CAR-T infusion and died at 6 weeks. Three patients relapsed with CD19+ disease. Of these, 1 died at 38 months after CAR-T infusion, another died at 17 months, and the third patient was alive at 28 months. The remaining 6 patients are alive and well at a median follow-up of 10 months (range 3 to 16 months) without recurrence of disease, according to the researchers.

Read more of Oncology Nurse Advisor's coverage of the 2017 American Society of Clinical Oncology Annual Meeting by visiting the conference page.

Reference

1. Talekar MK, Maude SL, Hucks GE, et al. Effect of chimeric antigen receptor-modified T (CAR-T) cells on responses in children with non-CNS extramedullary relapse of CD19+ acute lymphoblastic leukemia (ALL). Oral presentation at: 2017 American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago,IL.

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