Use of cardiac radiation therapy as bridging therapy to CAR-T for relapsed pediatric B-cell acute lymphoblastic leukemia

Cesar P Marquez; Raul Montiel-Esparza; Caressa Hui; Liora M Schultz; Kara L Davis; Richard T Hoppe; Sarah S Donaldson; Sneha Ramakrishna; Susan M Hiniker

doi:10.1002/pbc.28870

Use of cardiac radiation therapy as bridging therapy to CAR-T for relapsed pediatric B-cell acute lymphoblastic leukemia

Pediatr Blood Cancer. 2021 Mar;68(3):e28870. doi: 10.1002/pbc.28870. Epub 2020 Dec 23.

Authors

Cesar P Marquez^{1

2}, Raul Montiel-Esparza³, Caressa Hui², Liora M Schultz³, Kara L Davis³, Richard T Hoppe², Sarah S Donaldson², Sneha Ramakrishna³, Susan M Hiniker²

Affiliations

¹ School of Medicine, Stanford University, Stanford, California.
² Department of Radiation Oncology, Stanford University, Stanford, California.
³ Department of Pediatrics, Bass Center for Childhood Cancer and Blood Disorders, Center for Cancer Cell Therapy, Stanford University, Stanford, California.

PMID: 33355997
DOI: 10.1002/pbc.28870

Abstract

The use of radiotherapy as bridging therapy to chimeric antigen receptor T-cell therapy (CAR-T) in pre-B acute lymphoblastic leukemia (B-ALL) has been minimally explored. Here, we present a boy with B-ALL who relapsed after allogeneic bone marrow transplant with disseminated disease, including significant symptomatic cardiovascular and gastrointestinal (GI) involvement. The cardiac and GI leukemic infiltrates were successfully treated with bridging radiation therapy (BRT) prior to CAR-T infusion. Using this approach, he successfully tolerated CAR-T with no evidence of disease or sequelae on 3-month follow-up. This is the first reported case of safe and effective delivery of cardiac BRT in B-ALL.

Keywords: B-ALL; CAR-T; pediatric oncology; radiotherapy.

Publication types

Case Reports

MeSH terms

Adolescent
Cardiovascular Diseases / etiology
Cardiovascular Diseases / pathology
Cardiovascular Diseases / radiotherapy*
Cardiovascular Diseases / therapy
Combined Modality Therapy
Gastrointestinal Diseases / etiology
Gastrointestinal Diseases / pathology
Gastrointestinal Diseases / radiotherapy*
Gastrointestinal Diseases / therapy
Hematopoietic Stem Cell Transplantation / adverse effects*
Humans
Immunotherapy, Adoptive / methods
Leukemic Infiltration / etiology
Leukemic Infiltration / pathology
Leukemic Infiltration / radiotherapy
Leukemic Infiltration / therapy
Male
Neoplasm Recurrence, Local / etiology
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / radiotherapy*
Neoplasm Recurrence, Local / therapy
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / pathology
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / therapy*
Prognosis
Radiotherapy / methods*