Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access
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Case Report

Volume 13, Number 1-2, April 2024, pages 34-38

Successful Treatment of Refractory Post-Transplant Lymphoproliferative Disorder With Chimeric Antigen Receptor T-Cell Therapy in a Heart Transplant Recipient

Figures

Figure 1.
Figure 1. (a) Liver core biopsy showing monomorphic proliferation of neoplastic cells (at × 20 magnification). (b) Ebstein-Barr virus (EBV) stain showing positive nuclear staining of EBV-infected cells (at × 20 magnification). (c) CD20 stain showing positive membranous staining of B cells (at × 20 magnification).
Figure 2.
Figure 2. Positron emission tomography/computed tomography (PET/CT) over patient’s disease progression and treatment. (a) After rituximab: showing large mass in right lower lobe of the lung (yellow arrow) and lesions in segment 2 and 7 of the liver (red arrows). (b) After rituximab, cyclophosphamide, etoposide, vincristine, prednisone (R-CEOP) showing increase in size of the right lower lobe lesion (yellow arrow) now with central necrosis. Left lobe lesion in the liver resolved, but right lobe lesion remains. (c) After chimeric antigen receptor (CAR)-T cell therapy showing resolution of right lower lobe lesion with reduction in size of parahilar lesion (yellow arrow). Resolution of the liver lesions also noted. (d) Further reduction of the parahilar lesion 5 months post-CAR-T cell therapy (yellow arrow).

Table

Table 1. Key Clinical Factors in Cases Utilizing CAR T-Cell Therapy in PTLD of Heart Transplant Patients
 
CaseAge at CAR T-cell therapyTime to PTLD diagnosisType of PTLDPrior therapiesCAR T-cell therapy agentIS at apheresisIS at CAR T-cell therapyOutcomes post-CAR T-cell therapy
CAR: chimeric antigen receptor; CTLs: cytotoxic T lymphocytes; EBV: Ebstein-Barr virus; GemOx: gemcitabine-oxaliplatin; IS: immunosuppression; PET/CT: positron emission tomography/computed tomography; PTLD: post-transplant lymphoproliferative disorder; R-CEOP: rituximab, cyclophosphamide, etoposide, vincristine, prednisone; R-COPADM: rituximab, cyclophosphamide, oncovin (vincristine), prednisone, adriamycin (doxorubicin), methotrexate; R-CYVE: rituximab, cytarabine, etoposide; R-ICE: rituximab, ifosfamide, carboplatin, etoposide.
Hickmann et al695 monthsEBV+ monomorphicRituximab, R-CEOP, GemOxAxi-celStop tacrolimus; increase prednisonePrednisoneNo evidence of PTLD on PET/CT on day +100
Dang et al [2]184 monthsEBV+ monomorphicR-COP, R-COPADM, R-CYVE, EBV CTLsAxi-celPrednisone 5 mg tacrolimusUnknownNo evidence of PTLD on PET/CT on day +80
Oren et al [6]2322 years (3 years s/p kidney transplant)EBV+ monomorphicR-CHEOP, gemcitabine/carboplatinLiso-celUnknownTacrolimus, prednisoneNo evidence on PET/CT on +90
Krishnamoorthy et al [8]5426 yearsEBV- monomorphicR-CHOP, R-ICEAxi-cel--Death on day +44
McKenna et al [7]76UnknownUnknownR-Benda, radiationBrexu-cel--Complete remission