CD19/CD22 chimeric antigen receptor T-cell therapy for refractory acute B-cell lymphoblastic leukemia with FLT3-ITD mutations

Bone Marrow Transplant. 2020 Apr;55(4):717-721. doi: 10.1038/s41409-020-0807-7. Epub 2020 Jan 31.

Abstract

Treatment of acute lymphoblastic leukemia (ALL) is still a challenge despite years of researching, especially for those of poor prognosis. Zhang and his team recently proved that FLT3 gene mutation was identified in ~5% of ALL and the mutation spectrum is different from AML. Recently, chimeric antigen receptor T cells (CART) therapy presents great efficacy in treating refractory leukemia. We report a case of a refractory ALL patient with FLT3-ITD mutations and unfavorable karyotypes, who failed to respond to chemotherapy and small molecule tyrosine kinase inhibitors, successfully treated by CART therapy. FLT3-ITD mutations were downregulated dramatically into 14.1% positive 3 days after the infusion and remained negative until now. MRD has stayed to be negative from the 10th day. This case suggests that CART-cell therapy might be effective in treating FLT3-ITD positive refractory ALL, implying the possibility to overcome the traditional prognosis scoring system for leukemia and providing a new chance for other leukemia patients with inferior prognosis factors.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • B-Lymphocytes
  • Cell- and Tissue-Based Therapy
  • Humans
  • Leukemia, Myeloid, Acute*
  • Mutation
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma* / genetics
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma* / therapy
  • Prognosis
  • Receptors, Chimeric Antigen* / genetics
  • Sialic Acid Binding Ig-like Lectin 2
  • fms-Like Tyrosine Kinase 3 / genetics

Substances

  • CD22 protein, human
  • Receptors, Chimeric Antigen
  • Sialic Acid Binding Ig-like Lectin 2
  • FLT3 protein, human
  • fms-Like Tyrosine Kinase 3