CD19 chimeric antigen receptor T-cell therapy for the treatment of a patient with refractory Burkitt lymphoma after kidney transplant.

Abstract

CD19 chimeric antigen receptor (CAR) T-cell therapy has shown promise in treating post-transplant lymphoproliferative disorder, but the risk of graft rejection is acknowledged and there is no consensus on the use of calcineurin inhibitors with CAR T-cell therapy. We report a kidney transplant recipient with refractory Burkitt lymphoma who received cyclosporine A (CsA) following CD19 CAR T-cell infusion. Serial peripheral blood sampling was performed before and after CsA administration, and samples were analyzed via single-cell RNA sequencing. The patient exhibited robust CAR T-cell expansion and achieved a complete response. In vitro analyses demonstrated that CsA did not profoundly inhibit CAR T-cell activation, expansion or cytotoxicity. This case illustrates that the use of CsA following CAR T-cell therapy may be feasible and provides preliminary evidence supporting its investigation as a strategy for lowering the risk of graft rejection in patients with post-transplant lymphoproliferative disorder.