Secondary haematological dysplasia after <scp>CAR</scp>‐T‐cell therapy for acute lymphoblastic leukaemia in children
The use of CAR-T is becoming more widespread in the treatment of haematological malignancies. In adults, secondary myelodysplastic syndromes (MDS) after CAR-T have been described. However, there are currently no data on the risk of MDS following CAR-T in children treated for acute lymphoblastic leukaemia (ALL). We studied all children treated with CAR-T cells at Hospital Sant Joan de Déu in Barcelona and those with persistent cytopenias were evaluated at the cytological, cytogenetic, and molecular levels to look for MDS. A total of 106 patients received CAR-T for ALL. Among 40 patients without early relapse or subsequent therapy after CAR-T, four fulfilled the WHO criteria for myelodysplasia. These four patients had received a haematopoietic stem cell transplantation (HSCT) prior to CAR-T and presented cytopenias with severe dysplastic changes in bone marrow after CAR-T. One patient had clonal MDS with high-risk cytogenetics arising from the host cells requiring a HSCT. Three patients had non-progressive dysplasia arising from the donor cells. Two are alive in complete remission with stable cytopenias and one succumbed to ALL relapse. This is the first description of post-CAR-T MDS and haematological dysplasia in children and highlights the need to monitor children with persistent post-CAR-T cytopenias.
Authors
- Alexandre Théron (ORCID: https://orcid.org/0000-0001-8793-4903)
- Jaime Verdú‐Amorós (ORCID: https://orcid.org/0000-0002-0900-0889)
- Ignacio Isola
- Albert Català (ORCID: https://orcid.org/0000-0003-0133-1752)
- Susana Rives (ORCID: https://orcid.org/0000-0002-5658-1831)
- Monica López‐Duarte (ORCID: https://orcid.org/0000-0001-8134-9682)
- Edurne Sarrate (ORCID: https://orcid.org/0000-0003-2860-5557)
- Nazaret Sanchez‐Sierra
- Cristina Díaz de Heredia (ORCID: https://orcid.org/0000-0001-8086-296X)
- Núria Conde
- José Luís Dapena (ORCID: https://orcid.org/0000-0002-6711-7479)
- Anna Alonso‐Saladrigues (ORCID: https://orcid.org/0000-0002-3195-5470)
- Mireia Camós (ORCID: https://orcid.org/0000-0003-3658-7942)
- Elena Esperanza‐Cebollada (ORCID: https://orcid.org/0000-0001-5451-0370)
- Esther Cuatrecasas (ORCID: https://orcid.org/0000-0003-2881-4412)
- Montserrat Torrebadell (ORCID: https://orcid.org/0000-0002-0027-3215)
- Sandra Andreu
Institutions
- Hospital Sant Joan de Déu Barcelona (ES)
- Université de Montpellier (FR)
- Instituto de Salud Carlos III (ES)
- Marqués de Valdecilla University Hospital (ES)
- Vall d'Hebron Institut de Recerca (ES)
- Centre for Biomedical Network Research on Rare Diseases (ES)
- Hôpital Arnaud de Villeneuve (FR)
- INCLIVA Health Research Institute (ES)
- Instituto de Investigación de Enfermedades Raras (ES)
- Universitat de Barcelona (ES)
Publication Details
- Journal
- British Journal of Haematology
- Published
- 2024-10-28
- DOI
- https://doi.org/10.1111/bjh.19862
- Primary Topic
- CAR-T cell therapy research
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Fundació la Marató de TV3
- Instituto de Salud Carlos III