Successful Anti-CD 19 CAR-T Cell Therapy in Jehovah Witness Patient with Relapsed Refractory B-ALL

• Published in: Biology of blood and marrow transplantation 2020-03, Vol.26 (3), p.S379-S379
• Main Authors: Leal, Jordan, Rodriguez, Liza, Kus, Crissy, Appenfeller, Allison, Ganguly, Siddhartha, McGuirk, Joseph P., Abhyankar, Sunil, Singh, Anurag, Lin, Tara, Shune, Leyla
• Format: Article
• Language: English
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2019.12.168

Jehovah Witness is a minority Christian denomination whose members do not accept blood products. The population of Jehovah witness is approximately 1 million in the USA and 8 million worldwide. They are likely to be excluded from most clinical trials, including trials evaluating chimeric antigen receptor (CAR) T‐cell therapies for relapsed/refractory hematological malignancies. We hereby report a case of 20-year-old female, Jehovah Witness patient, with relapsed refractory B Cell Acute lymphoblastic lymphoma (B-ALL) who was successfully treated with anti‐CD19 CAR T‐cell product Tisagenlecleucel. The patient was initially diagnosed at age 13 in 2012 with B-ALL. She received treatment on a pediatric protocol and stayed in remission until 9/20/2018 when she presented with fatigue and Bone marrow biopsy with relapsed disease (85% B-ALL). Cytogenetics were 46XY and FISH negative for BCR/ABL. NGS was negative for a pathogenic variant, and Cerebrospinal fluid analysis was negative for B-ALL The patient was refractory to Inotuzumab and became eligible for Tisagenlecleucel. She underwent T-cell apheresis, lymphodepletion and CAR-T cell infusion per protocol She had no cytokine release syndrome or Immune effector cell-associated neurotoxicity syndrome She developed pancytopenia and received supportive care with Epoetin alfa, Folic acid, Vitamin B12, Ferrous sulfate, vitamin and Provera daily to suppress menses. We also minimize blood loss by using pediatric size collection tubes. She is currently at 6 months and remains in complete remission with count recovery. We present a case of a Jehovah witness patient with relapsed B-ALL successfully treated Tisagenlecleucel. Per a report from Maude et' al, CAR-T therapy has induced 90% complete remission rates among 30 children with relapsed refractory B-ALL, of whom 15 did not receive additional treatment. This is especially pertinent for our patient who could not have tolerated allogeneic stem cell transplant without transfusion support.