Lenalidomide Treatment of Isolated Central Nervous System Relapse in Acute Lymphoblastic Leukemia after Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T-Cell Therapy.
Acta Haematol
; 147(5): 592-597, 2024.
Article
in En
| MEDLINE
| ID: mdl-38359803
ABSTRACT
INTRODUCTION:
Hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor T (CAR-T) cell are effective treatments for acute lymphoblastic leukemia (ALL). Various forms of intra- and extramedullary relapses have been reported after HSCT and CAR-T-cell therapy for ALL; however, no reports have investigated isolated central nervous system (CNS) relapse after HSCT and CAR-T-cell therapy. Hence, no clinical treatment has been established for such rare patients. CASE PRESENTATION An 18-year-old male patient with B-cell ALL suffered from isolated CNS relapse after HSCT and CAR-T-cell therapy. Conventional systemic intravenous and intrathecal chemotherapies were ineffective and intolerable. A unique immunosuppressive microenvironment of decreasing NK cell percentage and increasing IL-8 concentration and CAR-T-cell exhaustion had been illustrated in the cerebrospinal fluid. Finally, the patient received immunomodulatory therapy with lenalidomide and obtained complete remission.CONCLUSION:
Lenalidomide might be a therapeutic strategy for isolated CNS relapse after HSCT and CAR-T-cell therapy.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Immunotherapy, Adoptive
/
Hematopoietic Stem Cell Transplantation
/
Precursor Cell Lymphoblastic Leukemia-Lymphoma
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Lenalidomide
Limits:
Adolescent
/
Humans
/
Male
Language:
En
Journal:
Acta Haematol
/
Acta haematol
/
Acta haematologica
Year:
2024
Document type:
Article
Country of publication: