CD19 CAR-T 治疗在实体器官移植受者中的应用：病例报告与系统综述

Post-transplant lymphoproliferative disorder (PTLD) is a leading cause of cancer death in solid organ transplant recipients (SOTRs). Relapsed or refractory (R/R) PTLD portends a high risk of death and effective management is not well established. CD19-targeted CAR-T cell therapy has been utilized, but the risks and benefits are unknown.

We report the first case of diffuse large B-cell lymphoma (DLBCL) PTLD treated with lisocabtagene maraleucel and present a systematic literature review of SOTRs with PTLD treated with CD19 CAR-T therapy.

Our patient achieved a complete response (CR) with limited toxicity but experienced a CD19 + relapse 8 months after infusion despite CAR-T persistence. Literature review revealed 14 DLBCL and 2 Burkitt lymphoma PTLD cases treated with CD19 CAR-T cells. Kidney (n = 12), liver (n = 2), heart (n = 2), and pancreas after kidney (n = 1) transplant recipients were analyzed.

The objective response rate (ORR) was 82. 4% (14/17), with 58. 5% (10/17) CRs and a 6. 5-month median duration of response. Among kidney transplant recipients, the ORR was 91. 7% (11/12). Allograft rejection occurred in 23. 5% (4/17). No graft failure occurred.

Our analysis suggests that CD19 CAR-T therapy offers short-term effectiveness and manageable toxicity in SOTRs with R/R PTLD.

Further investigation through larger datasets and prospective study is needed.