CD19-CAR T cells persist in the cerebrospinal fluid for months after treatment

More than 90% of children in the United States with B-cell acute lymphoblastic leukemia (B-ALL) survive. However, relapsed disease is still difficult to treat, including when the cancer has spread to the central nervous system. Chimeric antigen receptor (CAR) T–cell therapy, which reprograms a patient’s immune cells to target and destroy cancer cells, can help these patients. Unlike other treatments, these modified cells can access the central nervous system to attack leukemia cells. To learn more about how long these cells can survive in the central nervous system, Aimee Talleur, MD; Stephen Gottschalk, MD; and Swati Naik, MBBS, all of the Department of Bone Marrow Transplantation & Cellular Therapy, looked at cerebrospinal fluid (CSF) from 29 adolescent and young adults with relapsed B-ALL treated with CD19-CAR T–cell therapy. The researchers found CAR T cells remained in the fluid for months after treatment, although their numbers declined over time. Published in Leukemia, the findings provide the first insights into how the therapy may be utilized to improve outcomes and ultimately prevent CNS relapses.

“Our finding that CD19-CAR T cells can survive in the CSF for months after treatment raises the possibility of a curative option for patients with B-ALL in the CNS,” said Talleur. “This is important, because this is a condition that currently requires radiation, a treatment modality associated with significant side effects, to achieve and maintain remissions.”

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