CAR-T for Management of R/R PTLD Following Lung Transplant: A Multi-center Retrospective Study

Area of Science:

• Oncology
• Immunology
• Transplantation

Background:

• Post-transplant lymphoproliferative disorder (PTLD) is a rare malignancy after solid organ transplantation (SOT), with lung transplant recipients facing high mortality.
• CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy is effective for relapsed/refractory B-cell lymphoma, but its use in PTLD, especially post-lung SOT, is not well-established.

Purpose of the Study:

• To evaluate the feasibility and efficacy of Axicabtagene ciloleucel (Axicel) CAR-T therapy in lung transplant recipients with relapsed/refractory PTLD.
• To assess the safety and toxicity profile of CAR-T therapy in this specific patient population.
• To explore the optimal management of immunosuppression (IST) around CAR-T infusion to balance efficacy and allograft preservation.

Main Methods:

• A multi-center retrospective study involving three lung transplant recipients with relapsed/refractory PTLD treated with Axicel.
• Review of prior therapies, CAR-T treatment course, response, toxicity, and immunosuppression management.
• Analysis of cytokine release syndrome (CRS) and allograft outcomes.

Main Results:

• All three patients achieved complete or partial response to CAR-T therapy.
• Cytokine release syndrome (CRS) was observed in all patients but was mild and effectively managed.
• One patient experienced allograft rejection, highlighting the need for careful IST modification.

Conclusions:

• CAR-T therapy is a feasible treatment option for lung SOT recipients with PTLD, demonstrating promising responses and manageable toxicities.
• Individualized modification of immunosuppression around CAR-T infusion is crucial for balancing treatment efficacy with lung allograft preservation.
• Further research is needed to understand IST management in this complex patient subset, as current CAR-T studies often exclude them.