A case of B-cell lymphoblastic leukemia cutis flaring following CAR T-cell therapy in a patient with refractory acute lymphoblastic leukemia

Puri, Pranav; Severson, Kevin J.; Patel, Meera H.; Brumfiel, Caitlin M.; DiCaudo, David J.; Rosenthal, Allison; Mangold, Aaron R.

doi:10.1016/j.jdcr.2020.12.013

Cited by 1 publication

(3 citation statements)

References 4 publications

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“…4,5 This report adds to this knowledge by demonstrating serial histopathology consistent with CAR-T cells at work within leukemic infiltrates. 4,5 Additionally, our case highlights that hemophagocytosis could also be an attribute of effector function of CAR-T, a known extreme variant of CRS, carHLH. 6,7 Indeed, the flare of LC and the noted T-cell infiltrate with cellular debris and phagocytosis following CAR-T infusion likely indicate a favorable response, but data are limited to allow definitive conclusions about the long term prognostic and predictive value of this finding.…”

Section: Discussionmentioning

confidence: 55%

“…Case reports have also demonstrated flaring of LC in response to CAR‐T and that disease flare may not necessarily be indicative of CAR‐T therapy failure 4,5 . This report adds to this knowledge by demonstrating serial histopathology consistent with CAR‐T cells at work within leukemic infiltrates 4,5 . Additionally, our case highlights that hemophagocytosis could also be an attribute of effector function of CAR‐T, a known extreme variant of CRS, carHLH 6,7 .…”

Section: Discussionmentioning

confidence: 56%

“…CAR‐T cells have previously been shown to be able to infiltrate the skin and eliminate covert LC 4 . Case reports have also demonstrated flaring of LC in response to CAR‐T and that disease flare may not necessarily be indicative of CAR‐T therapy failure 4,5 . This report adds to this knowledge by demonstrating serial histopathology consistent with CAR‐T cells at work within leukemic infiltrates 4,5 .…”

Section: Discussionmentioning

confidence: 57%

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Histopathologic evidence of chimeric antigen receptor T‐cell therapy in lesions of B‐cell lymphoblastic leukemia cutis

Nihal,

Comstock,

Bennett

et al. 2024

J Cutan Pathol

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Histopathologic evidence of chimeric antigen receptor T-cell therapy in lesions of B-cell lymphoblastic leukemia cutis 1 | INTRODUCTION Chimeric antigen receptor T-cell (CAR-T) therapy is a form of potent immune effector cell therapy for relapsed lymphoid and plasma cell malignancies. 1 Evidence of the cytotoxic effects mediated by CAR-T has been reported primarily in preclinical in vivo and in vitro models. 2 Demonstration of pathological features in patients during active therapy is challenging, and therefore limited, owing to the nature of the hematologic malignancies. Here, we present a case of refractory B-cell acute lymphoblastic leukemia (B-ALL) with known leukemia cutis F I G U R E 1 (A, top left): Indurated, brown-violaceous plaques on the back, prior to chimeric antigen receptor T-cell therapy. (B, C, top right and right middle): 20Â, hematoxylin and eosin (H&E) and 400Â, H&E, respectively. Biopsy of back demonstrates a dermal, periadnexal, perivascular, interstitial, and nodular infiltrate of blastic-appearing mononuclear cells with fine chromatin. (D-H, bottom row): Immunoperoxidase staining demonstrates strong staining of lesional cells with CD19 (20Â, 3,3'-diaminobenzidine (DAB), D), CD34 (20Â, alkaline phosphatase red (APR), E), PAX-5 (20Â, DAB, F), TdT (20Â, DAB, G). CD3 staining (2Â, APR, H). These features support the diagnosis of cutaneous involvement of patient's known B-lymphoblastic leukemia/lymphoma.

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