{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T20:50:54Z","timestamp":1761598254070,"version":"build-2065373602"},"reference-count":22,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T00:00:00Z","timestamp":1600214400000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2020,8,6]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Relapsed\/refractory B-precursor acute lymphoblastic leukemia (BCP-ALL) remains a major therapeutic challenge in pediatric hematology. Chimeric antigen receptor (CAR) T cells targeting CD19 have shown remarkable initial response rates in BCP-ALL patients, while long-term leukemia control rate is only about 50%. So far, main mechanisms of BCP-ALL relapse after CD19-CAR T-cell therapy have been either insufficient CAR T-cell persistence in vivo or loss of surface CD19.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case Report<\/jats:title>\n                  <jats:p>Here, we report an exceptional presentation of BCP-ALL relapse in the eye during the systemic control through CAR T-cell therapy. We report a case of fatal intraocular relapse in a pediatric patient with pro-B-ALL after initial response to CD19-CAR T-cell therapy. One month after CD19-CAR T-cell therapy, remission was documented by bone marrow aspirate analysis with absence of CD19<jats:sup>+<\/jats:sup> cells and CD19-CAR T cells could be detected in both peripheral blood and bone marrow. At the same time, however, the patient presented with progressive visual disturbance and CD19<jats:sup>+<\/jats:sup> cells were found within the anterior chamber of the eye. Despite local and systemic therapy, ocular relapse led to BCP-ALL dissemination and systemic relapse within weeks. The eye represents a rare site for local manifestation of BCP-ALL, but isolated intraocular relapse is a clinically unreckoned presentation of BCP-ALL in the era of CD19-CAR T cells.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>During systemic control of BCP-ALL through CD19-CAR T cells, relapse can emerge in the eye as an immune-privileged organ. Ocular symptoms after CD19-CAR T-cell therapy should guide the clinician to elucidate the etiology in a timely fashion in order to adjust leukemia treatment strategy. Both, local immune escape as well as insufficient CAR T-cell persistence may have contributed to relapse in the reported patient. Mechanisms of relapse in an immune desert under CAR T-cell therapy require future clinical and experimental attention. In particular, ocular symptoms after CAR T-cell therapy should be considered a potentially early sign of leukemia relapse.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jitc-2020-001052","type":"journal-article","created":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T17:58:29Z","timestamp":1600279109000},"page":"e001052","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Leukemia escape in immune desert: intraocular relapse of pediatric pro-B-ALL during systemic control by CD19-CAR T cells"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9472-2191","authenticated-orcid":false,"given":"Semjon","family":"Willier","sequence":"first","affiliation":[{"name":"Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children\u2019s Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Raedler","sequence":"additional","affiliation":[{"name":"Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children\u2019s Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franziska","family":"Blaeschke","sequence":"additional","affiliation":[{"name":"Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children\u2019s Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Stenger","sequence":"additional","affiliation":[{"name":"Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children\u2019s Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany"},{"name":"German Cancer Research Center (DKFZ), Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Montserrat","family":"Pazos Escudero","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Jurgeleit","sequence":"additional","affiliation":[{"name":"Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children\u2019s Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas G P","family":"Gr\u00fcnewald","sequence":"additional","affiliation":[{"name":"German Cancer Research Center (DKFZ), Heidelberg, Germany"},{"name":"Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany"},{"name":"Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany"},{"name":"Partner site Munich, German Cancer Consortium (DKTK), Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera","family":"Binder","sequence":"additional","affiliation":[{"name":"Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children\u2019s Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Schmid","sequence":"additional","affiliation":[{"name":"Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children\u2019s Hospital, University Hospital, LMU Munich, Munich, Bavaria, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael H","family":"Albert","sequence":"additional","affiliation":[{"name":"Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner 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