Evolution to plasmablastic lymphoma evades CD19‐directed chimeric antigen receptor T cells

AG Evans, PG Rothberg, WR Burack… - British journal of …, 2015 - Wiley Online Library
AG Evans, PG Rothberg, WR Burack, SF Huntington, DL Porter, JW Friedberg, JL Liesveld
British journal of haematology, 2015Wiley Online Library
A patient with relapsed and refractory chronic lymphocytic leukaemia with Richter
transformation was treated with chimeric antigen receptor (CAR)‐modified T cells targeted
for CD19 but later relapsed with a clonally related plasmablastic lymphoma. The loss of most
routine markers of pre‐plasma cell or B lymphoid differentiation (including CD19) highlights
the ability of such mature lymphomas to evade lineage‐specific targeted immunotherapy by
differentiating along pathways comparable to their normal cellular counterparts. Molecular …
Summary
A patient with relapsed and refractory chronic lymphocytic leukaemia with Richter transformation was treated with chimeric antigen receptor (CAR)‐modified T cells targeted for CD19 but later relapsed with a clonally related plasmablastic lymphoma. The loss of most routine markers of pre‐plasma cell or B lymphoid differentiation (including CD19) highlights the ability of such mature lymphomas to evade lineage‐specific targeted immunotherapy by differentiating along pathways comparable to their normal cellular counterparts. Molecular genetic evaluation demonstrated multiple independent lines of CD19‐negative disease that eventually evolved in this single patient. Such plasticity represents potential challenges for antigen‐directed CAR‐T cell therapy, while serving as a testament to the selective pressure exerted by these engineered T cells over time.
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