An exceptional case of durable remission achieved with reinfusion of
CD19-directed CAR-T despite failure to induce B-cell aplasia and review
of institutional experience with reinfusion of tisagenlecleucel
Abstract
CD19-directed chimeric antigen receptor T lymphocytes (CAR-T) have led
to durable remissions in children with refractory and/or multiply
relapsed B-lymphoblastic leukemia. For those who relapse or lose B-cell
aplasia post-CAR-T, the role of CAR-T reinfusion is unclear. We report a
case of durable remission with tisagenlecleucel reinfusion despite
failure to achieve B-cell aplasia and compare this case to seven
additional children who received multiple tisagenlecleucel infusions at
our institution. Our experience suggests that reinfusion is safe and may
be a definitive therapy for a small subset of patients. Reinfusion can
also reintroduce remission and/or B-cell aplasia, allowing for
subsequent therapies.