Case report: Impact of BITE on CAR-T cell expansion

Abstract

Targeted immunotherapeutic approaches have become an attractive, novel therapy in the treatment of chemotherapy resistant or relapsed high-risk acute lymphoblastic leukemia (ALL). Many of these therapies, chimeric antigen receptor (CAR) T cells, and bispecific T-cell engagers (BiTE) in particular, rely on surface expression of the antigen for activity and efficacy. As such, antigen loss is a growing problem in this relapsed population. We present a case of relapsed, refractory B-ALL that has immunophenotypic variability in the leukemia blasts in response to the sequential targeted immunotherapies received. This case additionally describes a bolstered CAR-T cell expansion after the patient received subsequent blinatumomab therapy, suggesting a potential strategy for utilization of multiagent immunotherapies to have synergistic approaches to eradicate disease and prolong remission in patients with relapsed hematologic malignancies (Anti-CD22 chimeric receptor T cells in pediatric and young adult patients with recurrent or relapsed CD22-expressing B-cell malignancies. clinicaltrials.gov NCT02315612).