Relapsed Philadelphia Chromosome-Positive Pre-B-ALL after CD19-Directed CAR-T Cell Therapy Successfully Treated with Combination of Blinatumomab and Ponatinib

Acta Haematol. 2019;141(2):107-110. doi: 10.1159/000495558. Epub 2019 Jan 29.


Adults with relapsed or refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL) treated with conventional chemotherapy have dismal outcomes. Novel immunotherapies targeting CD19, including the bispecific T-cell engager blinatumomab and chimeric antigen-receptor T (CAR-T) cells, have revolutionized the treatment of R/R B-ALL. Robust response rates to CAR-T cell therapy after blinatumomab have recently been reported, but it is unknown whether blinatumomab can be effective following failure of anti-CD19 CAR-T cell therapy. Herein, we describe a patient with Philadelphia chromosome-positive B-ALL who relapsed after CD19-directed CAR-T therapy, but subsequently responded to the combination of blinatumomab and the tyrosine kinase inhibitor ponatinib, with the achievement of a complete remission lasting 12 months.

Keywords: Acute lymphoblastic leukemia; Blinatumomab; CD19 CAR-T cell; Philadelphia chromosome; Ponatinib.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Bispecific / therapeutic use*
  • Antigens, CD19 / metabolism*
  • Antineoplastic Agents / therapeutic use*
  • Cell- and Tissue-Based Therapy
  • Drug Therapy, Combination
  • Humans
  • Imidazoles / therapeutic use*
  • Male
  • Philadelphia Chromosome
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Pyridazines / therapeutic use*
  • Receptors, Antigen, T-Cell / therapeutic use
  • Recurrence


  • Antibodies, Bispecific
  • Antigens, CD19
  • Antineoplastic Agents
  • Imidazoles
  • Pyridazines
  • Receptors, Antigen, T-Cell
  • ponatinib
  • blinatumomab