Cancer Res Treat.  2018 Oct;50(4):1462-1466. 10.4143/crt.2017.473.

Delayed Terminal Ileal Perforation in a Relapsed/Refractory B-Cell Lymphoma Patient with Rapid Remission Following Chimeric Antigen Receptor T-Cell Therapy

• Hu Y
• Wang J
• Pu C
• Zhao K
• Cui Q
• Wei G
• Wu W
• Xiao L
• Xiao Y
• Wang J
• Wu Z
• Huang H

• KMID: 2424817
• DOI: http://doi.org/10.4143/crt.2017.473

Abstract

Chimeric antigen receptor T-cell strategy targeting CD19 (CART19) has prominent anti-tumor effect for relapsed/refractory B-cell lymphomas. CART19-associated complications have been gradually recognized, however, late-onset complications have not been extensively studied. Herein, for the first time we report a diffuse large B-cell lymphoma patient with terminal ileum involvement obtained rapid remission and developed spontaneous terminal ileal perforation 38 days following CART19 infusion. The late-onset perforation reminds us that, for the safety of CART treatment, more cautions are warranted for the management of delayed GI complications.

Keyword

Refractory/relapse; B-cell lymphoma; Chimeric antigen receptor T cells; Terminal ileal perforation

MeSH Terms

B-Lymphocytes*
Humans
Ileum
Lymphoma, B-Cell*
Receptors, Antigen*
T-Lymphocytes*
Receptors, Antigen

Figure

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  Fig. 1. The patient achieved complete remission 30 days after chimeric antigen receptor T-cell strategy targeting CD19 (CART19s) infusion with grade 2 cytokine release syndrome. (A) Positron emission tomography/computed tomography (PET/CT) showed lymphoma activities in the terminal ileum, the mesentery lymph nodes, the pancreatic tail, the left femur and the vertebral body of S2 pre-CART19 treatment. (B) PET/CT showed a complete remission 30 days post-CART19 treatment. (C) The patient developed fever 6 hours after CART19 infusion with the highest temperature 40.8°C and decreased to normal level after 5 days. (D) Serum levels of interleukin (IL)-6, IL-10, interferon γ (IFN-γ), C-reactive protein (CRP), D-dimer, and ferritin were elevated 2 days after the infusion and fell into the normal range within 4 days with supportive care.

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  Fig. 2. (A, B) In the exploratory laparotomy, a perforation in the terminal ileum (B) was discovered at the site coincident with the location of lymphoma involvement reflected in positron emission tomography/computed tomography scan before chimeric antigen receptor T-cell strategy targeting CD19 (CART19) infusion (A). (C) Pathological findings by H&E staining showed no lymphoma cells and partial necrotic tissue. (D) Immunochemical staining revealed a negative result for CART19.

Reference

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