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CASE REPORT article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2024 |
doi: 10.3389/fimmu.2024.1423487
This article is part of the Research Topic Immunotherapy in Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL) View all 8 articles
Sub-clinical Extramedullary B-ALL in the Setting of Relapse Following Targeted Therapy
Provisionally accepted
Claire Johns
*
Courtney Erickson
*
Ashley Jacobs
*
Jennifer Moon
*
Christina Baggot
*
Regina Dagher
*
Helen Nadel
Jay Balagtas
*
Catherine Aftandilian
*
Sneha Ramakrishna
*
Norman Lacayo
*
Kara Davis
Elliot Stieglitz
Liora Schultz
*- Stanford University, Stanford, United States
Standard testing for disease evaluation in B-cell acute lymphoblastic leukemia (B-ALL) includes examination of the bone marrow and cerebrospinal fluid. Radiographic or functional imaging are indicated when clinical signs of non-CNS extramedullary disease are present but are not standard in the relapsed/refractory setting. We describe two cases of patients with relapsed/refractory B-ALL with prior exposure to blinatumomab and/or inotuzumab ozogamicin presenting for CAR-T cell treatment. Both patients were thought to only have minimal residual disease (MRD) at the pre-CAR disease assessment, with MRD of 6,648 (0.66%) and 100 (0.01%) cells per million cells, respectively, as measured by next-generation sequencing (NGS) in their bone marrows. Both patients for distinct reasons unrelated to non-CNS extra-medullary (EM) symptoms had PET-MRIs prior to lymphodepletion and CAR T cell infusion. In both cases patients were found to have significant bulky subclinical EM disease that required changes in clinical management. In the newly-emergent era of antigen-targeted immunotherapy, it is foundational that incidence and relapse patterns following targeted therapy are well-understood. Herein we contribute to a growing body of literature addressing this fundamental clinical gap and highlight a future role for formal prospective imaging studies to better establish response, toxicity and relapse patterns following CAR-T cell therapy in EM B-ALL.
Keywords: Immunotherapy, CAR (chimeric antigen receptor) T cells, B ALL, extramedullary acute lymphoblastic leukemia, Relapsed/refractory leukemia
Received: 25 Apr 2024; Accepted: 27 Aug 2024.
Copyright: © 2024 Johns, Erickson, Jacobs, Moon, Baggot, Dagher, Nadel, Balagtas, Aftandilian, Ramakrishna, Lacayo, Davis, Stieglitz and Schultz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Claire Johns, Stanford University, Stanford, United States
Courtney Erickson, Stanford University, Stanford, United States
Ashley Jacobs, Stanford University, Stanford, United States
Jennifer Moon, Stanford University, Stanford, United States
Christina Baggot, Stanford University, Stanford, United States
Regina Dagher, Stanford University, Stanford, United States
Jay Balagtas, Stanford University, Stanford, United States
Catherine Aftandilian, Stanford University, Stanford, United States
Sneha Ramakrishna, Stanford University, Stanford, United States
Norman Lacayo, Stanford University, Stanford, United States
Liora Schultz, Stanford University, Stanford, United States
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