Kidney Transplant T-Cell-Mediated Rejection Occurring After Anti-CD19 CAR T-Cell Therapy for Refractory Aggressive Burkitt-like Lymphoma With 11q Aberration: A Case Report.

Fiche publication

Date publication

août 2021

Journal

American journal of kidney diseases : the official journal of the National Kidney Foundation

Auteurs

Membres identifiés du Cancéropôle Est :
Dr FERRAND Christophe

Tous les auteurs :
de Nattes T, Camus V, François A, Dallet G, Ferrand C, Guerrot D, Lemoine M, Morin F, Thieblemont C, Veresezan EL, Candon S, Latouche JB, Bertrand D

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/34461166

Résumé

Post-transplant lymphoproliferative disorder is a growing complication of kidney transplantation (KT) associated with a dismal prognosis. Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is a game-changing treatment option modifying the outcome of refractory hematological cancers. Here, we report the case of a 40-year-old KT patient who developed a Burkitt-like Lymphoma with 11q aberration five years after KT. After three unsuccessful lines of chemotherapy, it was decided to treat the patient with anti-CD19 CAR-T cells as a salvage therapy. Three months after CAR-T cell infusion, she experienced a grade II-B T-Cell-mediated rejection with severe tubulitis (T3), slight interstitial inflammation (I1) and severe intimal arteritis (V2) with blood suffusion. Among T-cells infiltrating the graft, some of them expressed the anti-CD19 CAR. CAR-T cells within the graft and in blood samples were also evidenced by droplet digital PCR. KT function improved after corticosteroids treatment and remained stable. However, lymphoma progressed with a massive pulmonary mass leading to the patient's death 10 months after CAR-T cell infusion.