CD19 CAR-T therapy in solid organ transplant recipients: case report and systematic review

Bone Marrow Transplant. 2023 Apr;58(4):353-359. doi: 10.1038/s41409-022-01907-z. Epub 2022 Dec 27.


Post-transplant lymphoproliferative disorder (PTLD) is a leading cause of cancer death in solid organ transplant recipients (SOTRs). Relapsed or refractory (R/R) PTLD portends a high risk of death and effective management is not well established. CD19-targeted CAR-T cell therapy has been utilized, but the risks and benefits are unknown. We report the first case of diffuse large B-cell lymphoma (DLBCL) PTLD treated with lisocabtagene maraleucel and present a systematic literature review of SOTRs with PTLD treated with CD19 CAR-T therapy. Our patient achieved a complete response (CR) with limited toxicity but experienced a CD19+ relapse 8 months after infusion despite CAR-T persistence. Literature review revealed 14 DLBCL and 2 Burkitt lymphoma PTLD cases treated with CD19 CAR-T cells. Kidney (n = 12), liver (n = 2), heart (n = 2), and pancreas after kidney (n = 1) transplant recipients were analyzed. The objective response rate (ORR) was 82.4% (14/17), with 58.5% (10/17) CRs and a 6.5-month median duration of response. Among kidney transplant recipients, the ORR was 91.7% (11/12). Allograft rejection occurred in 23.5% (4/17). No graft failure occurred. Our analysis suggests that CD19 CAR-T therapy offers short-term effectiveness and manageable toxicity in SOTRs with R/R PTLD. Further investigation through larger datasets and prospective study is needed.

Publication types

  • Systematic Review
  • Case Reports
  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antigens, CD19
  • Epstein-Barr Virus Infections*
  • Humans
  • Immunotherapy, Adoptive / adverse effects
  • Lymphoma, Large B-Cell, Diffuse* / pathology
  • Lymphoma, Large B-Cell, Diffuse* / therapy
  • Lymphoproliferative Disorders* / etiology
  • Lymphoproliferative Disorders* / therapy
  • Neoplasm Recurrence, Local
  • Organ Transplantation* / adverse effects
  • Receptors, Chimeric Antigen*
  • Transplant Recipients


  • Antigens, CD19
  • Receptors, Chimeric Antigen
  • CD19 molecule, human