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Durable remission with salvage decitabine and donor lymphocyte infusion (DLI) for relapsed early T-cell precursor ALL

Bone Marrow Transplantation volume 52, pages 1583–1584 (2017)Cite this article

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T-cell ALL (T-ALL) comprises ~25% of ALL diagnoses in adults,1 and remains an aggressive leukemia. T-ALL is a heterogenous disease classified according to different stages and surface markers expressed during T-cell development. Early T-cell precursor (ETP) ALL is defined by early intrathymic developmental arrest in T-cells. With the adaptation of pediatric-inspired multiagent chemotherapy regimens, the outcome in adult T-ALL has improved.2 Nevertheless, compared to the non-ETP-ALL type, ETP-ALL has a 10-year overall survival of only 19%.3 A purine nucleoside antimetabolite, nelarabine, has been approved for the treatment of patients with T-ALL and T-cell lymphoblastic lymphoma whose disease has not responded to or has relapsed following treatment with at least two chemotherapy regimens.4 Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been adopted with curative intent for treatment of patients with ALL in the first or second CR,5 who can tolerate this treatment modality. For elderly or medically unfit patients with persistent ALL, clinical trials and other salvage therapy are the only treatment options.

A 73-year-old Caucasian man was diagnosed with T-ALL without central nervous system involvement in 2003 at the age of 60. The original bone marrow biopsy and aspirate showed >20% blasts expressing CD5, CD7 with cytoplasmic CD3 and aberrant expression of myeloid antigens CD13, CD33 and CD117 without myeloperoxidase expression. FISH showed normal male karyotype, 46-XY. He was treated per MRC UKALL XII/ECOG E2993 protocol7 with intrathecal methotrexate prophylaxis. After achieving CR, he continued treatment with four cycles of multiagent consolidation chemotherapy followed by maintenance therapy per protocol.

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Authors and Affiliations

  1. University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA,

    F El Chaer, N Holtzman, E Binder, A P Rapoport & A Emadi

  2. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    F El Chaer, N Holtzman, E Binder, A P Rapoport & A Emadi

  3. Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA

    N C Porter

  4. Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA

    Z N Singh & M Koka

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Correspondence to A Emadi.

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El Chaer, F., Holtzman, N., Binder, E. et al. Durable remission with salvage decitabine and donor lymphocyte infusion (DLI) for relapsed early T-cell precursor ALL. Bone Marrow Transplant 52, 1583–1584 (2017). https://doi.org/10.1038/bmt.2017.191

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