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Shen MX, Li FL, Luo XS, Wang ZM. An effective treatment and suspicious adverse reaction to Ibrutinib in a patient diagnosed with splenic B-cell lymphoma/leukaemia with prominent nucleoli: A first case report. Medicine (Baltimore) 2023; 102:e36022. [PMID: 38206706 PMCID: PMC10754594 DOI: 10.1097/md.0000000000036022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/16/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE Splenic B-cell lymphoma/leukemia with prominent nucleoli (SBLPN) is a new classification, which is so rare that it lacks clinical data. PATIENT CONCERNS An increased proportion of prolymphocytes (84%) in the bone marrow smear. Whole exon sequence analysis revealed a TP53 mutation. DIAGNOSES Combining the clinical features with laboratory test results led to a diagnosis of SBLPN which was made according to the 5th edition of the WHO classification of hematolymphoid tumors, although the patient was diagnosed with B-PLL when guided by the 4th edition of the WHO classification. INTERVENTIONS The use of Ibrutinib as an effective treatment. OUTCOMES The patient was in complete remission after 5 months of Ibrutinib and then died of sudden aortic dissection. LESSONS Ibrutinib was an effective regimen for SBLPN. Aortic dissection might be considered as a suspicious adverse reaction to Ibrutinib.
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Affiliation(s)
- Mei-Xiao Shen
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Fu-Ling Li
- Department of Pharmacy, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Xian-Sheng Luo
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Zhi-Ming Wang
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
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2
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Oka S, Ono K, Nohgawa M. Effective upfront treatment with low-dose ibrutinib for a patient with B cell prolymphocytic leukemia. Invest New Drugs 2020; 38:1598-1600. [PMID: 31965420 DOI: 10.1007/s10637-020-00902-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
B cell prolymphocytic leukemia (B-PLL) is a rare and aggressive disease that is associated with poor survival. Although initially asymptomatic patients do not require therapy, most patients will progress and inevitably require treatment. More than 50% of patients with B-PLL carry abnormalities in the TP53 tumor suppressor gene and/or complex karyotype and show resistance to conventional chemotherapy. The efficacy of ibrutinib, a B cell receptor inhibitor, for B-PLL with the TP53 abnormality as second-line therapy was recently demonstrated. We herein report that low-dose ibrutinib as upfront therapy induced a complete response in a B-PLL patient with the TP53 abnormality, whose condition has since remained stable with no recurrence for 12 months. Effective treatments for B-PLL are lacking and given its rarity, prospective comparative therapies are not yet available. This case suggests that upfront therapy with ibrutinib improves the outcome of B-PLL.
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Affiliation(s)
- Satoko Oka
- Division of Hematology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Wakayama, Japan.
| | - Kazuo Ono
- Division of Pathology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Masaharu Nohgawa
- Division of Hematology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Wakayama, Japan
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3
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Cross M, Dearden C. B and T cell prolymphocytic leukaemia. Best Pract Res Clin Haematol 2019; 32:217-228. [PMID: 31585622 DOI: 10.1016/j.beha.2019.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
Prolymphocytic leukaemias B-PLL and T-PLL are rare disorders, typically with an aggressive clinical course and poor prognosis. Combining morphology, immunophenotyping, cytogenetic and molecular diagnostics reliably separates B-PLL and T-PLL from one another and other disorders. In T-PLL discovery of frequent mutations in the JAK-STAT pathway have increased understanding of disease pathogenesis. Alemtuzumab (anti-CD52) produces excellent response rates but long-term remissions are only achieved in a minority following consolidation with allogeneic stem cell transplant. Molecular abnormalities in B-PLL are less understood. Disruption of TP53 is a key finding, conveying chemotherapy resistance requiring novel therapies such as B-cell receptor inhibitors (BCRi). Both conditions require improved pathobiological knowledge to identify new treatment targets and guide therapy with novel pathway inhibitors.
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Affiliation(s)
- M Cross
- The Royal Marsden Hospital and the Institute of Cancer Research, UK
| | - C Dearden
- The Royal Marsden Hospital and the Institute of Cancer Research, UK.
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4
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Abstract
PURPOSE OF REVIEW We aimed to produce a comprehensive update on clinical and biological data regarding two rare lymphoid neoplasms, B and T prolymphocytic leukemias, and assess therapeutic management in the light of new molecular insights and the advent of targeted therapies. RECENT FINDINGS B cell prolymphocytic leukemia (B-PLL) diagnosis remains challenging in the absence of clear immunophenotypic or cytogenetic signature and overlap with mantle cell lymphoma. New molecular defects have been identified in T cell prolymphocytic leukemia (T-PLL), especially in the JAK STAT pathway. Like in chronic lymphocytic leukemia (CLL), B-PLL treatment depends on the presence of TP53 dysfunction. In T-PLL, alemtuzumab still remains the standard of care. Allogeneic transplantation is the only curable option. Thanks to reduced intensity conditioning regimens, it has become accessible to a larger number of patients. PLL prognosis remains poor with conventional therapies. However, great advances in the understanding of both T- and B-PLL pathogenesis lead to promising new therapeutic agents.
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5
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Gordon MJ, Raess PW, Young K, Spurgeon SEF, Danilov AV. Ibrutinib is an effective treatment for B-cell prolymphocytic leukaemia. Br J Haematol 2016; 179:501-503. [DOI: 10.1111/bjh.14224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Max J. Gordon
- Department of Medicine; Oregon Health and Science University; Portland OR USA
| | - Philipp W. Raess
- Department of Pathology; Oregon Health and Science University; Portland OR USA
| | - Kathleen Young
- Department of Medicine; Oregon Health and Science University; Portland OR USA
| | | | - Alexey V. Danilov
- Department of Medicine; Oregon Health and Science University; Portland OR USA
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6
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Fujiwara K, Fukuhara T, Kitano H, Okazaki T. Infiltration of the thyroid gland by T-cell prolymphocytic leukemia. Thyroid 2014; 24:1314-8. [PMID: 24762052 DOI: 10.1089/thy.2013.0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND T-cell prolymphocytic leukemia (T-PLL) is rare, accounting for only 0.06% of all malignant lymphomas, and is classified as a T-cell mature lymphoma. The disease affects mainly elderly patients and is characterized by splenomegaly, lymphadenopathy, skin infiltration, and a high leukocyte count, but thyroid filtration has never been detected as far as we could determine. We report here a case of infiltration of the thyroid gland by T-PLL. PATIENT FINDINGS An 89-year-old woman who had been treated for Hashimoto's thyroiditis for 20 years presented with a progressively enlarging thyroid mass accompanied by dyspnea and dysphasia. Atypical lymphocytes with irregular nuclei were observed in the peripheral blood. An open biopsy of the thyroid provided pathological evidence of T-PLL, and bone marrow examination showed infiltration by T-PLL. The diagnosis was therefore infiltration of the thyroid gland by T-PLL. Chemotherapy was initiated, but six months after termination, recurrence of neck swelling was observed. The patient was then treated with radiotherapy, but she died of a major stroke 15 months after onset. SUMMARY AND CONCLUSION This is the first report of T-PLL infiltration of the thyroid gland, reminding physicians to keep in mind a broad differential diagnosis when encountering a patient with diffuse thyroid lesions and abnormal lymphocytes in the peripheral blood.
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Affiliation(s)
- Kazunori Fujiwara
- 1 Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University , Yonago, Japan
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7
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Matutes E, Else M, Catovsky D. B-cell prolymphocytic leukemia and hairy cell leukemia: new advances in biology and treatment. Int J Hematol Oncol 2012. [DOI: 10.2217/ijh.12.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY B-cell prolymphocytic leukemia and hairy cell leukemia are mature lymphoid neoplasms recognized by WHO classification as distinct entities. The diagnosis relies on a constellation of clinical and laboratory features. B-cell prolymphocytic leukemia is a rare disease that lacks a genetic signature and represents a challenge to clinicians, due to the limited information on its pathogenesis, the difficulty of setting up prospective clinical trials and its refractoriness to treatments used in other chronic lymphoid neoplasms. By contrast, major advances have taken place in the understanding of the pathogenesis of hairy cell leukemia, as well as in the therapeutic armamentarium available for this disease. In this review, data will be presented on the natural history, pathogenesis, diagnosis and current therapies for these two leukemias.
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Affiliation(s)
- Estella Matutes
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Monica Else
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Daniel Catovsky
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
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8
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Abstract
T- and B-cell subtypes of prolymphocytic leukemia (PLL) are rare, aggressive lymphoid malignancies with characteristic morphologic, immunophenotypic, cytogenetic, and molecular features. Recent studies have highlighted the role of specific oncogenes, such as TCL-1, MTCP-1, and ATM in the case of T-cell and TP53 mutations in the case of B-cell prolymphocytic leukemia. Despite the advances in the understanding of the biology of these conditions, the prognosis for these patients remains poor with short survival and no curative therapy. The advent of monoclonal antibodies has improved treatment options. Currently, the best treatment for T-PLL is intravenous alemtuzumab, which has resulted in very high response rates of more than 90% when given as first-line treatment and a significant improvement in survival. Consolidation of remissions with autologous or allogeneic stem cell transplantation further prolongs survival, and the latter may offer potential cure. In B-PLL, rituximab-based combination chemo-immunotherapy is effective in fitter patients. TP53 abnormalities are common and, as for chronic lymphocytic leukemia, these patients should be managed using an alemtuzumab-based therapy. The role of allogeneic transplant with nonmyeloablative conditioning needs to be explored further in both T- and B-cell PLL to broaden the patient eligibility for what may be a curative treatment.
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Abstract
Before the contemporary development of rationally designed antineoplastic therapies, cladribine was identified as a lymphocyte-specific agent. Its profound impact on the natural history of hairy cell leukemia, with responses approaching 100% and a median duration of response of nearly a decade after only a single 7-day course, is well known and revolutionized the treatment of hairy cell leukemia. However, cladribine's impressive activity in other lymphoproliferative disorders has been generally underappreciated. Multiple single-arm phase 2 trials have demonstrated cladribine's potency across the full spectrum of lymphoid malignancies. In a limited number of phase 3 trials and cross-study analyses, cladribine compared favorably with fludarabine, another purine nucleoside analog that is more commonly used in the treatment of indolent lymphoid malignancies. Cladribine has been noted to have particular activity among lymphoid disorders with few effective therapies, specifically, chronic lymphocytic leukemia, lymphoplasmacytic lymphoma, marginal zone lymphoma, and mantle cell lymphoma. Recently approved novel agents may act in synergy with cladribine for these conditions and should be incorporated into future clinical studies.
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Abstract
The leukemias of mature B cells and T cells are a limited set of diseases in which blood and bone marrow are the primary sites of involvement. Although they may superficially resemble one another, they have distinct clinical and pathologic features and must be distinguished from one another. In this article, the major clinical, morphologic, phenotypic, and molecular genetic features of the mature B- and T-cell leukemias are reviewed, and differential diagnostic considerations are discussed.
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Affiliation(s)
- Eric D Hsi
- Section of Hematopathology, Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH 44195, USA.
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11
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Robak T, Korycka A, Lech-Maranda E, Robak P. Current status of older and new purine nucleoside analogues in the treatment of lymphoproliferative diseases. Molecules 2009; 14:1183-226. [PMID: 19325518 PMCID: PMC6253893 DOI: 10.3390/molecules14031183] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/27/2009] [Accepted: 03/10/2009] [Indexed: 01/29/2023] Open
Abstract
For the past few years more and more new cytotoxic agents active in the treatment of hematological malignancies have been synthesized and become available for either in vitro studies or clinical trials. Among them the class of antineoplastic drugs belonging to the purine nucleoside analogues group (PNAs) plays an important role. Three of them: pentostatin (DCF), cladribine (2-CdA) and fludarabine (FA) were approved by Food and Drug Administration (FDA) for the treatment of hematological malignancies. Recently three novel PNAs: clofarabine (CAFdA), nelarabine (ara-G) and forodesine (immucillin H, BCX-1777) have been synthesized and introduced into preclinical studies and clinical trials. These agents seem to be useful mainly for the treatment of human T-cell proliferative disorders and they are currently undergoing clinical trials in lymphoid malignancies. However, there are also several studies suggesting the role of these drugs in B-cell malignancies. This review will summarize current knowledge concerning the mechanism of action, pharmacologic properties, clinical activity and toxicity of PNAs accepted for use in clinical practice, as well as new agents available for clinical trials.
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Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, 93-510 Lodz, Ciolkowskiego 2 Str., Poland.
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12
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Dungarwalla M, Matutes E, Dearden CE. Prolymphocytic leukaemia of B- and T-cell subtype: a state-of-the-art paper. Eur J Haematol 2008; 80:469-76. [PMID: 18331594 DOI: 10.1111/j.1600-0609.2008.01069.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Dungarwalla
- Haemato-oncology Unit, The Royal Marsden Hospital, London, UK
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13
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Robak T. Emerging drugs for rarer chronic lymphoid leukemias. Expert Opin Emerg Drugs 2008; 13:95-118. [PMID: 18321151 DOI: 10.1517/14728214.13.1.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rarer indolent lymphoid leukemias include well defined mature B-cell and T-cell neoplasm with widely varying natural history and specific morphological, immunophenotypic and molecular characteristics. Among these are prolymphocytic leukemia (PLL), hairy cell leukemia (HCL) and its variants, large granular lymphocyte leukemia (LGLL) and adult T-cell leukemia/lymphoma (ATLL). OBJECTIVE To present current therapies and emerging drugs potentially useful in the treatment of rarer chronic lymphoid leukemias. METHODS After searching MEDLINE, PubMed and the Current Contents database, and conference proceedings from the previous 3 years of the American Society of Hematology (ASH), the European Society of Hematology (EHA) and the American Society of Clinical Oncology (ASCO) were searched manually; articles written in English and additional relevant publications were then selected. RESULTS/CONCLUSION New drugs including monoclonal antibodies (mAbs), new purine analogs, small molecules targeting specific molecular targets and other agents are included. Future research should focus on the novel therapeutic strategies based on the molecular pathogenic mechanisms and the development of new targeted therapies for each distinct chronic lymphoid leukemia.
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Affiliation(s)
- Tadeusz Robak
- Medical University of Lodz, Copernicus Memorial Hospital, Department of Hematology, 93-510 Lodz, ul. Ciołkowskiego 2, Poland.
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14
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Lin TS, Byrd JC. Chronic Lymphocytic Leukemia and Related Chronic Leukemias. Oncology 2007. [DOI: 10.1007/0-387-31056-8_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Ravandi F, O'Brien S. Chronic lymphoid leukemias other than chronic lymphocytic leukemia: diagnosis and treatment. Mayo Clin Proc 2005; 80:1660-74. [PMID: 16342661 DOI: 10.4065/80.12.1660] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The World Health Organization classification divides lymphoid malignancies into precursor B-cell and T-cell neoplasms as well as mature B-cell and T-cell neoplasms. Mature B-cell neoplasms comprise more than 85% of non-Hodgkin lymphomas worldwide and can be further subclassified according to the postulated cell of origin by using specific morphologic, immunophenotypic, and molecular characteristics. Similarly, the more uncommon mature T-cell neoplasms have been better characterized to include numerous distinct entities with widely varying natural histories. The distinction between lymphoma and leukemia is somewhat arbitrary and is based on variable involvement of the bone marrow, peripheral blood, and lymphatic system. In this article, we review the diagnostic and clinical features of mature B-cell and T-cell lymphoproliferative disorders that commonly have a leukemic presentation.
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MESH Headings
- Diagnosis, Differential
- Humans
- Leukemia, Hairy Cell/diagnosis
- Leukemia, Hairy Cell/therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, T-Cell/diagnosis
- Leukemia, T-Cell/therapy
- Prognosis
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Affiliation(s)
- Farhad Ravandi
- Department of Leukemia, The University of Texas M D Anderson Cancer Center, Houston 77030, USA.
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Abstract
Prolymphocytic leukemia is a rare chronic lymphoproliferative disorder that includes two subtypes, B cell and T cell, each with its own distinct clinical, laboratory and pathological features. T-cell prolymphocytic leukemia has an aggressive course with short median survival and poor response to chemotherapy. With the use of the purine analogue pentostatin more than half of patients will have a major response and a minority will have a complete remission, usually lasting months. With the introduction of alemtuzumab, most patients who progressed despite treatment with pentostatin had a major response with a complete remission rate higher than that obtained with pentostatin when used as a first line. Unfortunately, progression still follows shortly. We recommend alemtuzumab as initial therapy and offer stem cell transplant (SCT) to selected young, healthy patients who respond. Although B-cell prolymphocytic leukemia is also a progressive disease, some patients can achieve a prolonged progression-free-survival with fludarabine. Patients presenting with massive splenomegaly may be effectively palliated with splenic irradiation or splenectomy. Rituximab is a promising agent and further investigations are warranted to better define its role in treatment of this disorder.
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MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal, Murine-Derived
- Antibodies, Neoplasm/administration & dosage
- Antineoplastic Agents/therapeutic use
- Female
- Humans
- Leukemia, B-Cell/therapy
- Leukemia, Prolymphocytic/therapy
- Leukemia, T-Cell/therapy
- Male
- Pentostatin/administration & dosage
- Rituximab
- Stem Cell Transplantation
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Affiliation(s)
- Ahmed Absi
- Taussig Cancer Cancer, The Cleveland Clinic Foundation, 9500 Euclid Avenue R35, Cleveland OH 44195, USA
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Castagna L, Nozza A, Bertuzzi A, Siracusano L, Timofeeva I, Santoro A. Allogeneic peripheral blood stem cell transplantation with reduced intensity conditioning in primary refractory prolymphocytic leukemia: graft-versus-leukemia effect without graft-versus-host disease. Bone Marrow Transplant 2001; 28:1155-6. [PMID: 11803359 DOI: 10.1038/sj.bmt.1703309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2001] [Accepted: 09/06/2001] [Indexed: 11/08/2022]
Abstract
A patient with progressive prolymphocytic leukemia (PLL) received an allogeneic stem cell transplant using a reduced intensity conditioning regimen to avoid prohibitive toxicities. Early in the post-transplant period, a high donor-derived CD8+ count was observed. One year from transplantation, the patient was in complete remission, fully donor chimeric and with a normal performance status, suggesting that this approach may represent a useful treatment option in patients with refractory PLL.
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Affiliation(s)
- L Castagna
- Department of Medical Oncology and Hematology, Instituto Clinico Humanitas, 56 via Manzoni, 20089 Rozzano, Milan, Italy
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