CAR-T therapy in solid transplant recipients with post-transplant lymphoproliferative disease: case report and literature review
Rafael Hernani, Asunción Sancho, Paula Amat, Juan Carlos Hernández‐Boluda, Ariadna Pérez, José Luís Piñana, Carlos Carretero, Rosa Goterris, Montse Gómez, Ana Saus, Blanca Ferrer Lores, Ana Isabel Teruel, María José Terol, Carlos Solano
Abstract
Patients with postransplant lymphoproliferative disease (PTLD) who are refractory to rituximab-based regimens have extremely poor prognosis. Data is lacking in the setting of solid organ transplantation (SOT)-related PTLD treated with chimeric antigen receptor T-cell (CAR-T) therapy. Moreover, limited information is available on the influence of concomitant immunosuppressive drugs on CAR-T function. Here, we describe the clinical outcome in one PTLD patient and propose a strategy for tailoring immunosuppressive treatment and organ monitoring in patients with kidney allografts after CAR-T infusion. This report also reviews the limited published data in the setting of SOT-related PTLD treated with CAR-T, which appears to be a feasible treatment in this clinical scenario, without severe toxicity and capable of inducing sustained responses. A noteworthy finding is that in most reported cases patients underwent complete or partial discontinuation of immunosuppressive drugs, with only one documented case of allograft rejection.