Interventions and outcomes of adult patients with B-ALL progressing after CD19 chimeric antigen receptor T-cell therapy Journal Article


Authors: Wudhikarn, K.; Flynn, J. R.; Rivière, I.; Gönen, M.; Wang, X.; Senechal, B.; Curran, K. J.; Roshal, M.; Maslak, P. G.; Geyer, M. B.; Halton, E. F.; Diamonte, C.; Davila, M. L.; Sadelain, M.; Brentjens, R. J.; Park, J. H.
Article Title: Interventions and outcomes of adult patients with B-ALL progressing after CD19 chimeric antigen receptor T-cell therapy
Abstract: CD19-targeted chimeric antigen receptor (CAR) T-cell therapy has become a breakthrough treatment of patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL). However, despite the high initial response rate, the majority of adult patients with B-ALL progress after CD19 CAR T-cell therapy. Data on the natural history, management, and outcome of adult B-ALL progressing after CD19 CAR T cells have not been described in detail. Herein, we report comprehensive data of 38 adult patients with B-ALL who progressed after CD19 CAR T therapy at our institution. The median time to progression after CAR T-cell therapy was 5.5 months. Median survival after post–CAR T progression was 7.5 months. A high disease burden at the time of CAR T-cell infusion was significantly associated with risk of post–CAR T progression. Thirty patients (79%) received salvage treatment of post–CAR T disease progression, and 13 patients (43%) achieved complete remission (CR), but remission duration was short. Notably, 7 (58.3%) of 12 patients achieved CR after blinatumomab and/or inotuzumab administered following post–CAR T failure. Multivariate analysis revealed that a longer remission duration from CAR T cells was associated with superior survival after progression following CAR T-cell therapy. In summary, overall prognosis of adult B-ALL patients progressing after CD19 CAR T cells was poor, although a subset of patients achieved sustained remissions to salvage treatments, including blinatumomab, inotuzumab, and reinfusion of CAR T cells. Novel therapeutic strategies are needed to reduce risk of progression after CAR T-cell therapy and improve outcomes of these patients. © 2021 American Society of Hematology
Journal Title: Blood
Volume: 138
Issue: 7
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2021-08-19
Start Page: 531
End Page: 543
Language: English
DOI: 10.1182/blood.2020009515
PUBMED: 33851211
PROVIDER: scopus
PMCID: PMC8377478
DOI/URL:
Notes: Article -- Export Date: 1 September 2021 -- Source: Scopus
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MSK Authors
  1. Renier J Brentjens
    286 Brentjens
  2. Mithat Gonen
    1034 Gonen
  3. Kevin Joseph Curran
    150 Curran
  4. Jae Hong Park
    378 Park
  5. Elizabeth F Halton
    53 Halton
  6. Michel W J Sadelain
    587 Sadelain
  7. Isabelle C Riviere
    242 Riviere
  8. Peter Maslak
    197 Maslak
  9. Xiuyan Wang
    121 Wang
  10. Mikhail Roshal
    236 Roshal
  11. Mark Blaine Geyer
    91 Geyer
  12. Jessica Flynn
    182 Flynn