Department of Hematology & Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China.
Nanjing CART Medical Technology Co. Ltd, Nanjing, China.
Immunotherapy. 2021 Jan;13(1):5-10. doi: 10.2217/imt-2020-0188. Epub 2020 Oct 12.
CD19-targeted chimeric antigen receptor (CAR) T-cell therapy has emerged as a powerful immunotherapy in relapsed or refractory B-cell acute lymphoblastic leukemia. The changes in extramedullary (EM) disease in pediatric relapsed or refractory B-cell acute lymphoblastic leukemia after CAR T-cell therapy have rarely been reported. A child with relapsed B-ALL was treated with CAR T-cell therapy. Bone marrow morphological examination, minimal residual disease, fusion mutation and radiological evaluation of the EM disease were performed before and after CAR T-cell infusion. Radiological assessment revealed a distinct asymptomatic pseudo progression of EM involvements on day 16 after CAR T-cell infusion. Pseudoprogression of EM disease indicates heterogeneous immune-related patterns of response in patients treated with CAR-T therapy. Such patients should be closely monitored and practical immune-related response criteria should be developed for them.
嵌合抗原受体（CAR）T 细胞疗法针对 CD19 已成为复发或难治性 B 细胞急性淋巴细胞白血病的一种强大的免疫疗法。CAR T 细胞治疗后儿科复发或难治性 B 细胞急性淋巴细胞白血病的髓外（EM）疾病变化很少有报道。一例复发性 B-ALL 患儿接受了 CAR T 细胞治疗。在 CAR T 细胞输注前后进行了骨髓形态学检查、微小残留病、融合突变和 EM 疾病的影像学评估。放射学评估显示，CAR T 细胞输注后第 16 天，EM 受累出现明显的无症状假性进展。EM 疾病的假性进展表明接受 CAR-T 治疗的患者存在异质性的免疫相关反应模式。此类患者应密切监测，并为其制定实用的免疫相关反应标准。
