Treatment Of Relapsed And Refractory Acute Myeloid Leukemia (MDs Transformation) With CD123 Chimeric Antigen Receptor T Cell And Literature Review

Objective:The gene express anti-CD123 chimeric antigen receptor(CD123-CART)was modified to the patient T cells,then the CD123-CART cells were assessed with the safety and efficacy in a patients with relapsed refractory acute myeloid leukemia(MDS transformation).Methods:A 48-year-old man with relapsed refractory acute myeloid leukemia(transformation of myelodysplastic syndrome)received a single infusion of anti-CD123-CART cells after pretreatment with cyclophosphamide and fludarabine.The clinical response of the infusion and post-infusion was assessed by monitoring the patient's temperature,blood pressure,and blood routine every day,monitoring the inflammatory factor and peripheral blood flow at least once a week,and monitoring the bone marrow flow at least once a month.Results:The efficacy and complications of treatment with CD123-CART in the patient was evaluated.The patient was given a single infusion of CD123-CART cells,which showed a significant anti-tumor effect,with 48% of the original cells in the bone marrow before infusion and 2% on the 14 th day after the cell infusion.After the infusion,serum cytokines and CRP levels were observed to rise sharply.The patient developed severe fever,capillary leakage and other CRS reactions,central nervous system toxicity,which was controled after the application of dexamethasone and IL-6 inhibitors.After the infusion,the patient experienced a bone marrow suppression period of up to 3 months but eventually relapsed.Conclusions:1.The results demonstrated the feasibility and effectiveness of CD123-CART cells in the treatment of relapsed and refractory acute myeloid leukemia with MDS transformation.This case was the first reported at home.2.Long-term myelosuppression caused by infusion of CD123-CART in this patient may be related to the conversion of MDS by patients with myeloproliferative disorders,and it was may be related to the long-term myelosuppression by CD123-CART.3.Leukemia cells no longer express CD123 when the patient relapses,and are no longer recognized by CD123-CART cells as an important cause of recurrence,indicating that this treatment requires bridging hematopoietic stem cell transplantation for complete cure.