Dr Lee on Polatuzumab Vedotin/Glofitamab and CD19 CAR T-Cell Therapy in Pediatric Refractory Burkitt Lymphoma

[Because] we were able to get him in remission with really no toxicity, [the patient] was able to go on to get a consolidative stem cell transplant, and now he’s over 13 months after his CAR T[-cell] infusion and still disease free.

Daniel W. Lee, III, MD, an associate professor of pediatrics in the Division of Pediatric Hematology/Oncology at the University of Virginia School of Medicine, a member of the UVA Comprehensive Cancer Center, and director of pediatric hematopoietic stem cell transplantation and immunotherapy at UVA Health Children’s in Charlottesville, discussed a first-in-child case in which polatuzumab vedotin-piiq (Polivy) plus glofitamab-gxbm (Columvi), then modulated CD19-directed CAR T-cell therapy, induced remission in a child with primary refractory Burkitt lymphoma. The case was presented at the 2026 SITC Annual Meeting.

The patient, a 7-year-old male with stage IV Burkitt leukemia/lymphoma with a large abdominal mass and 97% bone marrow involvement, was refractory to 4 cycles of rituximab (Rituxan) plus chemotherapy. While he recovered from surgical debulking, the team collected and stored his peripheral blood mononuclear cells via apheresis, a fortuitous decision because the aggressiveness of Burkitt lymphoma leaves little opportunity to pause chemotherapy to collect T cells, Lee explained.

The investigators then developed pediatric dosing for polatuzumab vedotin and glofitamab, Lee said, following a New England Journal of Medicine publication that showed 3 adults with relapsed/refractory Burkitt leukemia/lymphoma achieved a complete metabolic response with the combination. The pediatric patient achieved a complete metabolic response after the third cycle, with no cytokine release syndrome (CRS) or immune effector cell–associated neurotoxicity syndrome (ICANS), Lee explained.

The patient later relapsed with CD20-negative disease in a single lymph node, prompting a pivot to CAR T-cell therapy, Lee noted. However, experience with CD19-directed CAR T cells in Burkitt lymphoma is minimal and responses have been poor, so the team sought to augment the response, he added. Because the relapsed tumor was infiltrated with immunosuppressive M2 macrophages expressing PD-L1 and CSF-1R, the patient received tisagenlecleucel (Kymriah) with the PD-L1 inhibitor atezolizumab (Tecentriq) and the CSF-1R inhibitor axatilimab-csfr (Niktimvo), a regimen dubbed T-ATAX. He achieved a complete metabolic response by day 56 without CRS, ICANS, or immune-related adverse effects.

Achieving a second remission with minimal toxicity allowed the patient to proceed to transplant, Lee emphasized.