Immune effector cell‐associated neurotoxicity syndrome (ICANS) is a frequent adverse event after Chimeric antigen receptor T cells (CAR‐T cells). A patient treated with anti‐CD19 CAR‐T cells for a refractory mantle cell lymphoma presented at Day 8 post‐infusion with extensive myelitis. Unusual eosinophilia was disclosed in the patient's cerebrospinal fluid. After treatment with methylprednisolone and siltuximab, a decrease in clinical symptoms and magnetic resonance imaging lesions were obtained. This unprecedented presentation of eosinophilic meningitis after CAR‐T cells therapy highlights the need for a better understanding of the physiopathology of ICANS, especially to identify potentially targetable pathways.
Therapeutic options in B-acute lymphoblastic leukemia (ALL)
relapses after anti-CD19 CAR-T cells are still debated. Here, we
analysed leukemic cells of a young patient who had several
CD19 relapses of B-ALL after hematopoietic stem cells
transplant (HSCT) and after anti-CD19 CAR-T cells (tisagenlecleucel).
Extensive membrane immunophenotype revealed the appearance of new
targets. Lysis sensibility analysis performed by Cr
release and long term killing assays revealed the in vitro
persistence of sensitivity to cytolytic activity of CAR-T cells. An
immunosuppressive monocytic population was identified in the last
relapse sample. Mechanisms leading to ALL resistance are analysed and
therapeutic options are discussed.
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