Leukemia escape in immune desert: intraocular relapse of pediatric pro-B-ALL during systemic control by CD19-CAR T cells

• DOI: 10.1136/jitc-2020-001052
• Publication Date: 2020-09-16T21:58:29Z
• Authors: Semjon Willier; Johannes Raedler; Franziska Blaeschke; Dana Stenger; Montserrat Pazos ...; Florian Jurgeleit; Thomas G P Grünewald; Vera Binder; Irene Schmid; Michael H Albert; Armin Wolf; Tobias Feuchtinger
• Keywords: Hematology; Cell therapy

Background Relapsed/refractory B-precursor acute lymphoblastic leukemia (BCP-ALL) remains a major therapeutic challenge in pediatric hematology. Chimeric antigen receptor (CAR) T cells targeting CD19 have shown remarkable initial response rates BCP-ALL patients, while long-term control rate is only about 50%. So far, main mechanisms of relapse after CD19-CAR T-cell therapy been either insufficient CAR persistence vivo or loss surface CD19. Case Report Here, we report an exceptional presentation the eye during systemic through therapy. We case fatal intraocular patient with pro-B-ALL to One month therapy, remission was documented by bone marrow aspirate analysis absence + and could be detected both peripheral blood marrow. At same time, however, presented progressive visual disturbance were found within anterior chamber eye. Despite local ocular led dissemination weeks. The represents rare site for manifestation BCP-ALL, but isolated clinically unreckoned era cells. Conclusion During cells, can emerge as immune-privileged organ. Ocular symptoms should guide clinician elucidate etiology timely fashion order adjust treatment strategy. Both, immune escape well may contributed reported patient. Mechanisms desert under require future clinical experimental attention. In particular, considered potentially early sign relapse.