ABSTRACT
INTRODUCTION: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood, arising from the bone marrow. ALL may present at diagnosis or relapse at extramedullary sites. In recent years, autologous T-cells engineered to express a chimeric-antigen receptor (CAR-T cells) have emerged as novel immune-based therapies for relapsed and refractory ALL, targeting the B-cell surface antigen CD19. Here we present a patient with relapsed ALL involving the ovaries, treated with CD19 CAR-T cells. Toxicity included cytokine-release syndrome and neurotoxicity. CAR-T cell therapy led to a complete remission, with evidence of CAR-T cell trafficking to disease sites including the bone marrow and ovaries.
Subject(s)
Burkitt Lymphoma , Immunotherapy, Adoptive , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Receptors, Chimeric Antigen , Female , Humans , Antigens, CD19 , Cell- and Tissue-Based Therapy , Ovary/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapyABSTRACT
The syndrome of hemorrhagic shock and encephalopathy is associated with an acute onset of diarrhea, followed by shock, disseminated intravascular coagulopathy, multiorgan failure, and encephalopathy. The etiology of this syndrome is unknown, and despite intensive treatment, the outcome is often fatal or associated with severe neurological sequelae. Two infants aged 6 and 9 months were admitted with this syndrome within a 24-hour time interval. The authors hereby present the clinical course and a prospective evaluation of the neurological outcome. A review of the literature regarding this infrequent syndrome is presented.