Abstract
According to the literature, lineage switch after CAR-T-cell infusion has been described in four cases of B-ALL, including three patients with mixed lineage leukemia (MLL) rearrangement,[1,2] and one pediatric patient with TCF3-ZNF384 fusion. In the present case, the interval between exposure to multidrug chemotherapy including cyclophosphamide and AML relapse was 5 years and 4 months. [...]the possibility cannot be ruled out that AML was secondary to chemotherapy drugs. [...]lineage switch after CD19-directed therapy is a specific mechanism of CAR resistance, with leukemic cells switching from one cell line to another after complete phenotypic alteration, and usually concerns patients with MLL rearrangement.
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