Histopathologic evidence of chimeric antigen receptor T‐ cell therapy in lesions of B‐cell lymphoblastic leukemia cutis

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Chimeric antigen receptor T-cell (CAR-T) therapy is a form of potent immune effector cell therapy for relapsed lymphoid and plasma cell malignancies.1 Evidence of the cytotoxic effects mediated by CAR-T has been reported primarily in preclinical in vivo and in vitro models.2 Demonstration of pathological features in patients during active therapy is challenging, and therefore limited, owing to the nature of the hematologic malignancies.Here, we present a case of refractory B-cell acute lymphoblastic leukemia (B-ALL) with known leukemia cutisF I G U R E 1 (A, top left): Indurated, brown-violaceous plaques on the back, prior to chimeric antigen receptor T-cell therapy.(B, C, top right and right middle): 20Â, hematoxylin and eosin (H&E) and 400Â, H&E, respectively.Biopsy of back demonstrates a dermal, periadnexal, perivascular, interstitial, and nodular infiltrate of blastic-appearing mononuclear cells with fine chromatin.(D-H, bottom row): Immunoperoxidase staining demonstrates strong staining of lesional cells with CD19 (20Â, 3,3'-diaminobenzidine (DAB), D), CD34 (20Â, alkaline phosphatase red (APR), E), PAX-5 (20Â, DAB, F), TdT (20Â, DAB, G).CD3 staining (2Â, APR, H).These features support the diagnosis of cutaneous involvement of patient's known B-lymphoblastic leukemia/lymphoma.

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