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Antibody-mediated autoimmune-like hepatitis is a rare and challenging occurrence after hematopoietic cell transplant (HCT). We present the case of a 16-year-old male patient with Ph+ ALL who underwent matched sibling donor HCT and developed autoimmune-like hepatitis after receiving ponatinib for post-HCT maintenance, evidenced by marked plasma cell infiltrate on liver biopsy. He was successfully treated with steroids and daratumumab, an anti-CD38-monoclonal antibody. The dramatic response in this patient warrants expanded investigation of daratumumab for plasma cell-mediated disorders post-HCT. It further highlights that identifying mechanisms of immune-mediated injury can allow for directed therapy and limit exposure to broad immune suppression.
Rebecca Epperly; Teresa Santiago; Cara E. Morin; Kurt Patton; Jeff Deyo; John Eshun; Brandon Triplett; Akshay Sharma. Targeting plasma cells with daratumumab aids in the treatment of post‐transplant autoimmune‐like hepatitis. Pediatric Blood & Cancer 2021, e29290 .
AMA StyleRebecca Epperly, Teresa Santiago, Cara E. Morin, Kurt Patton, Jeff Deyo, John Eshun, Brandon Triplett, Akshay Sharma. Targeting plasma cells with daratumumab aids in the treatment of post‐transplant autoimmune‐like hepatitis. Pediatric Blood & Cancer. 2021; ():e29290.
Chicago/Turabian StyleRebecca Epperly; Teresa Santiago; Cara E. Morin; Kurt Patton; Jeff Deyo; John Eshun; Brandon Triplett; Akshay Sharma. 2021. "Targeting plasma cells with daratumumab aids in the treatment of post‐transplant autoimmune‐like hepatitis." Pediatric Blood & Cancer , no. : e29290.
Outcomes for pediatric patients with acute myeloid leukemia (AML) remain poor, highlighting the need for improved targeted therapies. Building on the success of CD19-directed immune therapy for acute lymphocytic leukemia (ALL), efforts are ongoing to develop similar strategies for AML. Identifying target antigens for AML is challenging because of the high expression overlap in hematopoietic cells and normal tissues. Despite this, CD123 and CD33 antigen targeted therapies, among others, have emerged as promising candidates. In this review we focus on AML-specific T cell engaging bispecific antibodies and chimeric antigen receptor (CAR) T cells. We review antigens being explored for T cell-based immunotherapy in AML, describe the landscape of clinical trials upcoming for bispecific antibodies and CAR T cells, and highlight strategies to overcome additional challenges facing translation of T cell-based immunotherapy for AML.
Rebecca Epperly; Stephen Gottschalk; Mireya Velasquez. Harnessing T Cells to Target Pediatric Acute Myeloid Leukemia: CARs, BiTEs, and Beyond. Children 2020, 7, 14 .
AMA StyleRebecca Epperly, Stephen Gottschalk, Mireya Velasquez. Harnessing T Cells to Target Pediatric Acute Myeloid Leukemia: CARs, BiTEs, and Beyond. Children. 2020; 7 (2):14.
Chicago/Turabian StyleRebecca Epperly; Stephen Gottschalk; Mireya Velasquez. 2020. "Harnessing T Cells to Target Pediatric Acute Myeloid Leukemia: CARs, BiTEs, and Beyond." Children 7, no. 2: 14.
Secondary hemophagocytic syndrome (HPS) has been described after autologous hematopoietic cell transplant (AutoHCT). We report two cases of secondary HPS after novel consolidation therapy for high-risk neuroblastoma as part of an institutional phase 2 trial incorporating immunotherapy into a "standard" AutoHCT regimen. Both patients developed liver dysfunction beyond expected course of hepatic veno-occlusive disease, coagulopathy, hyperferritinemia, and when evaluated, elevated soluble interleukin-2 receptor and hemophagocytosis. These cases highlight the need for clinicians to have a high index of suspicion for immune-related complications in patients receiving immune therapies.
Rebecca Epperly; Wayne Furman; Melissa Hines; Teresa Santiago; Ying Li; Renee Madden; Ewelina Mamcarz; David Cervi; Sara Federico; Brandon Triplett; Aimee Talleur. Secondary hemophagocytic syndrome after autologous hematopoietic cell transplant and immune therapy for neuroblastoma. Pediatric Blood & Cancer 2019, 66, e27964 .
AMA StyleRebecca Epperly, Wayne Furman, Melissa Hines, Teresa Santiago, Ying Li, Renee Madden, Ewelina Mamcarz, David Cervi, Sara Federico, Brandon Triplett, Aimee Talleur. Secondary hemophagocytic syndrome after autologous hematopoietic cell transplant and immune therapy for neuroblastoma. Pediatric Blood & Cancer. 2019; 66 (11):e27964.
Chicago/Turabian StyleRebecca Epperly; Wayne Furman; Melissa Hines; Teresa Santiago; Ying Li; Renee Madden; Ewelina Mamcarz; David Cervi; Sara Federico; Brandon Triplett; Aimee Talleur. 2019. "Secondary hemophagocytic syndrome after autologous hematopoietic cell transplant and immune therapy for neuroblastoma." Pediatric Blood & Cancer 66, no. 11: e27964.
Post‐transplant lymphoproliferative disorder (PTLD) related plasma cell neoplasms are rare in pediatric patients. We report a pediatric liver transplant recipient with plasma cell myeloma type PTLD. Cytogenetics included 1q duplication, associated with poor prognosis in adult multiple myeloma, and t(8;14). High‐risk cytogenetics has not been reported in pediatric plasma cell myeloma type PTLD. The patient was treated with bortezomib, dexamethasone, and lenalidomide with subsequent autologous stem cell transplant. He achieved a 6‐year remission, demonstrating tolerance to and efficacy of this modern myeloma regimen in a pediatric patient. Unfortunately, he subsequently died from complications of repeat liver transplant.
Rebecca Epperly; John Ozolek; Kyle Soltys; Debra Cohen; Rakesh Goyal; Erika Friehling. Treatment of pediatric plasma cell myeloma type post-transplant lymphoproliferative disorder with modern risk-directed therapy. Pediatric Blood & Cancer 2018, 65, e27283 .
AMA StyleRebecca Epperly, John Ozolek, Kyle Soltys, Debra Cohen, Rakesh Goyal, Erika Friehling. Treatment of pediatric plasma cell myeloma type post-transplant lymphoproliferative disorder with modern risk-directed therapy. Pediatric Blood & Cancer. 2018; 65 (10):e27283.
Chicago/Turabian StyleRebecca Epperly; John Ozolek; Kyle Soltys; Debra Cohen; Rakesh Goyal; Erika Friehling. 2018. "Treatment of pediatric plasma cell myeloma type post-transplant lymphoproliferative disorder with modern risk-directed therapy." Pediatric Blood & Cancer 65, no. 10: e27283.