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Role of peripheral blood MRD and 18F-FDG PET in the post-CAR relapse setting: a case study of discordant peripheral blood and bone marrow MRD

Chimeric antigen receptor (CAR) T cell therapy is an effective salvage therapy for pediatric relapsed B-cell acute lymphoblastic leukemia (B-ALL), yet is challenged by high rates of post-CAR relapse. Literature describing specific relapse patterns and extramedullary (EM) sites of involvement in the...

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Autores principales: Schultz, Liora, Davis, Kara Lynn, Walkush, Ann, Baggott, Christina, Erickson, Courtney, Ramakrishna, Sneha, Aftandilian, Catherine, Lacayo, Norman, Nadel, Helen Ruth, Oak, Jean, Mackall, Crystal L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9972424/
https://www.ncbi.nlm.nih.gov/pubmed/36849202
http://dx.doi.org/10.1136/jitc-2022-004851
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author Schultz, Liora
Davis, Kara Lynn
Walkush, Ann
Baggott, Christina
Erickson, Courtney
Ramakrishna, Sneha
Aftandilian, Catherine
Lacayo, Norman
Nadel, Helen Ruth
Oak, Jean
Mackall, Crystal L
author_facet Schultz, Liora
Davis, Kara Lynn
Walkush, Ann
Baggott, Christina
Erickson, Courtney
Ramakrishna, Sneha
Aftandilian, Catherine
Lacayo, Norman
Nadel, Helen Ruth
Oak, Jean
Mackall, Crystal L
author_sort Schultz, Liora
collection PubMed
description Chimeric antigen receptor (CAR) T cell therapy is an effective salvage therapy for pediatric relapsed B-cell acute lymphoblastic leukemia (B-ALL), yet is challenged by high rates of post-CAR relapse. Literature describing specific relapse patterns and extramedullary (EM) sites of involvement in the post-CAR setting remains limited, and a clinical standard for post-CAR disease surveillance has yet to be established. We highlight the importance of integrating peripheral blood minimal residual disease (MRD) testing and radiologic imaging into surveillance strategies, to effectively characterize and capture post-CAR relapse. Main body: Here, we describe the case of a child with multiply relapsed B-ALL who relapsed in the post-CAR setting with gross non-contiguous medullary and EM disease. Interestingly, her relapse was identified first from peripheral blood flow cytometry MRD surveillance, in context of a negative bone marrow aspirate (MRD <0.01%). Positron emission tomography with 18F-fluorodeoxyglucose revealed diffuse leukemia with innumerable bone and lymph node lesions, interestingly sparing her sacrum, the site of her bone marrow aspirate sampling. Conclusions: We highlight this case as both peripheral blood MRD and 18F-fluorodeoxyglucose positron emission tomography imaging were more sensitive than standard bone marrow aspirate testing in detecting this patient’s post-CAR relapse. Clinical/Biologic Insight: In the multiply relapsed B-ALL setting, where relapse patterns may include patchy medullary and/or EM disease, peripheral blood MRD and/or whole body imaging, may carry increased sensitivity at detecting relapse in patient subsets, as compared with standard bone marrow sampling.
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spelling pubmed-99724242023-03-01 Role of peripheral blood MRD and 18F-FDG PET in the post-CAR relapse setting: a case study of discordant peripheral blood and bone marrow MRD Schultz, Liora Davis, Kara Lynn Walkush, Ann Baggott, Christina Erickson, Courtney Ramakrishna, Sneha Aftandilian, Catherine Lacayo, Norman Nadel, Helen Ruth Oak, Jean Mackall, Crystal L J Immunother Cancer Case Report Chimeric antigen receptor (CAR) T cell therapy is an effective salvage therapy for pediatric relapsed B-cell acute lymphoblastic leukemia (B-ALL), yet is challenged by high rates of post-CAR relapse. Literature describing specific relapse patterns and extramedullary (EM) sites of involvement in the post-CAR setting remains limited, and a clinical standard for post-CAR disease surveillance has yet to be established. We highlight the importance of integrating peripheral blood minimal residual disease (MRD) testing and radiologic imaging into surveillance strategies, to effectively characterize and capture post-CAR relapse. Main body: Here, we describe the case of a child with multiply relapsed B-ALL who relapsed in the post-CAR setting with gross non-contiguous medullary and EM disease. Interestingly, her relapse was identified first from peripheral blood flow cytometry MRD surveillance, in context of a negative bone marrow aspirate (MRD <0.01%). Positron emission tomography with 18F-fluorodeoxyglucose revealed diffuse leukemia with innumerable bone and lymph node lesions, interestingly sparing her sacrum, the site of her bone marrow aspirate sampling. Conclusions: We highlight this case as both peripheral blood MRD and 18F-fluorodeoxyglucose positron emission tomography imaging were more sensitive than standard bone marrow aspirate testing in detecting this patient’s post-CAR relapse. Clinical/Biologic Insight: In the multiply relapsed B-ALL setting, where relapse patterns may include patchy medullary and/or EM disease, peripheral blood MRD and/or whole body imaging, may carry increased sensitivity at detecting relapse in patient subsets, as compared with standard bone marrow sampling. BMJ Publishing Group 2023-02-27 /pmc/articles/PMC9972424/ /pubmed/36849202 http://dx.doi.org/10.1136/jitc-2022-004851 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Case Report
Schultz, Liora
Davis, Kara Lynn
Walkush, Ann
Baggott, Christina
Erickson, Courtney
Ramakrishna, Sneha
Aftandilian, Catherine
Lacayo, Norman
Nadel, Helen Ruth
Oak, Jean
Mackall, Crystal L
Role of peripheral blood MRD and 18F-FDG PET in the post-CAR relapse setting: a case study of discordant peripheral blood and bone marrow MRD
title Role of peripheral blood MRD and 18F-FDG PET in the post-CAR relapse setting: a case study of discordant peripheral blood and bone marrow MRD
title_full Role of peripheral blood MRD and 18F-FDG PET in the post-CAR relapse setting: a case study of discordant peripheral blood and bone marrow MRD
title_fullStr Role of peripheral blood MRD and 18F-FDG PET in the post-CAR relapse setting: a case study of discordant peripheral blood and bone marrow MRD
title_full_unstemmed Role of peripheral blood MRD and 18F-FDG PET in the post-CAR relapse setting: a case study of discordant peripheral blood and bone marrow MRD
title_short Role of peripheral blood MRD and 18F-FDG PET in the post-CAR relapse setting: a case study of discordant peripheral blood and bone marrow MRD
title_sort role of peripheral blood mrd and 18f-fdg pet in the post-car relapse setting: a case study of discordant peripheral blood and bone marrow mrd
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9972424/
https://www.ncbi.nlm.nih.gov/pubmed/36849202
http://dx.doi.org/10.1136/jitc-2022-004851
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