Use of Targeted T-Cell Therapy (Posoleucel) for the Treatment of Epstein-Barr Virus Associated Leiomyosarcoma in an Adult Kidney Transplant Recipient: A Case Report
1Renal Division, Brigham and Women's Hospital, Boston, MA, 2Dana Farber Cancer Institute, Boston, MA, 3Pathology, Brigham and Women's Hospital, Boston, MA, 4Allovir, Cambridge, MA
Meeting: 2022 American Transplant Congress
Abstract number: 1000
Keywords: Epstein-Barr virus (EBV), Malignancy, T cells, Viral therapy
Topic: Clinical Science » Infection Disease » 25 - Kidney Infectious Non-Polyoma & Non-Viral Hepatitis
Session Information
Session Name: Kidney Infectious Non-Polyoma & Non-Viral Hepatitis
Session Type: Poster Abstract
Date: Sunday, June 5, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Epstein-Barr virus (EBV)-associated leiomyosarcomas (EBV+LMS) are neoplasms rarely seen in solid organ transplant (SOT) recipients and currently lack effective treatment options. We present a kidney transplant recipient (KTR) with EBV+LMS treated with posoleucel (formerly known as ALVR105), an off-the-shelf, investigational T-cell immunotherapy that can target multiple viruses (EBV, BK, CMV, AdV, HHV-6 and JCV) on a single patient IND.
*Methods: A 34-year-old female KTR presented 3 years following transplantation with severe hypercalcemia (14.4 mg/dl), elevated creatinine, lymphopenia, and EBV viral load of 4128 IU/ml in peripheral blood. She endorsed fatigue, anorexia, and night sweats. PET-CT(Fig. 1A) showed multiple FDG-avid liver lesions, a splenic lesion, periportal adenopathy, and left femoral head lesion. Liver biopsy (Fig.2) revealed IHC negative for CD20, positive for smooth muscle actin and in situ hybridization for EBV-encoded RNA, consistent with EBV+LMS. She received 3 cycles (9 doses) of a different cellular immunotherapy on clinical trial with “stable disease” but clear radiographic improvement and then mild progression before receiving Posoleucel (Fig. 1B)
*Results: The patient received 6 doses of 4×107 cells (3 weekly, then 3 every other week) over a 2-month period. PET-CT at 1 and 3 months showed improvement though still termed “stable disease”. Liver lesions demonstrated increased central necrosis with SUVmax 6.8 from 10.6, 5.5 from 6.6, and 4.5 and 6; periportal adenopathy had SUVmax 8.8 from 10.9; and femoral lesion showed decreased FDG intensity. EBV viral load is no longer quantifiable at 3 months. No significant adverse events noted.
*Conclusions: EBV+LMS is a rare neoplasm which can lead to significant morbidity and mortality in SOT recipients. There is currently no standard approach to therapy. multivirus specific T-cell therapy, such as posoleucuel, offers a targeted approach to consider for EBV-driven malignancies in SOT recipients.
To cite this abstract in AMA style:
Saranu R, Nikiforow S, Jo V, So H, Stowe P, Tripathi S, Cardarelli F, Chandraker A. Use of Targeted T-Cell Therapy (Posoleucel) for the Treatment of Epstein-Barr Virus Associated Leiomyosarcoma in an Adult Kidney Transplant Recipient: A Case Report [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/use-of-targeted-t-cell-therapy-posoleucel-for-the-treatment-of-epstein-barr-virus-associated-leiomyosarcoma-in-an-adult-kidney-transplant-recipient-a-case-report/. Accessed January 18, 2025.« Back to 2022 American Transplant Congress