Successful CAR T Cell Therapy in a Heart and Kidney Transplant Recipient With Refractory PTLD

Post-transplant lymphoproliferative disorder (PTLD) refers to a wide array of immunosuppression related complications following solid organ transplantation. Improved long-term solid organ transplant graft survival in the last decade has been followed by increased reports of Epstein-Barr virus (EBV)- negative PTLD, which extends well beyond the first 18 months post-transplantation.(1) Recent data from 2018 estimated the incidence of PTLD at 2.24 per 1,000 patient years.(2) Despite substantial advancements in medical therapy, most notably the anti-CD20 monoclonal antibody, rituximab, which alone or in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone has improved survival outcomes for patients with diffuse large B cell lymphoma, outcomes for patients with refractory PTLD remain poor.(3) In the past 5 years, trials have demonstrated the effectiveness of chimeric antigen receptor (CAR) T cell therapy in providing a durable response against refractory diffuse large B cell lymphoma.(4) However, data on the use of CAR T cell therapy in solid organ transplant recipients and heart transplantation specifically are limited. Herein we describe the case of a 23-year-old woman with remote history of heart transplantation with subsequent kidney transplantation who developed refractory PTLD successfully treated with CAR T cell therapy.

Automated summary

Post-transplant lymphoproliferative disorder (PTLD) is a complication following solid organ transplantation that is related to immunosuppression. The incidence of PTLD, particularly EBV-negative PTLD, has increased in recent years. Despite advancements in medical therapy, outcomes for patients with refractory PTLD remain poor. CAR T cell therapy has shown effectiveness in treating refractory PTLD, but data on its use in solid organ transplant recipients and specifically heart transplantation are limited.