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Long-term survival following post-allograft relapse of T-cell acute lymphoblastic leukaemia: a novel approach using nelarabine and donor lymphocyte infusions

Bone Marrow Transplantation volume 53, pages 344–346 (2018)Cite this article

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Therapeutic options for relapsed T-cell acute lymphoblastic leukaemia (ALL) are limited, especially when disease recurs in the first year after allogeneic haematopoietic stem cell transplantation (HSCT) [1]. We report a novel and worthwhile approach with nelarabine and donor lymphocyte infusions (DLIs).

A 37-year old male with neurofibromatosis type 1 (NF1) presented in May 2014 with a petechial rash, lymphadenopathy and lethargy. Laboratory results included haemoglobin 97 g/l, white blood cells (WBC) 102 × 109/l and platelets 16 × 109/l. Blood film showed medium to large blasts with occasional hand-mirror forms. Bone marrow biopsy demonstrated over 90% lymphoid blasts (cCD3+, CD2/4/7/8+, CD34-, CD1a+, TdT+ on flow cytometry) in keeping with cortical T-cell ALL. Karyotype was normal but loss of 1 copy of ETV6 (12p13) was detected by fluorescence in-situ hybridisation. Central nervous system (CNS) involvement was confirmed with meningeal thickening and enhancement on magnetic resonance imaging (MRI) and the presence of lymphoblasts in cerebrospinal fluid (CSF). The patient was treated according to the UKALL XIV trial in which the T-cell arm explores the role of nelarabine in consolidation (ISRCTN 66541317), but was randomised to receive standard therapy alone. Twice weekly intrathecal methotrexate was administered until CSF blast clearance.

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Acknowledgements

KB is an NIHR academic clinical fellow.

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Authors and Affiliations

  1. Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK

    K Burley, J Wolf & DI Marks

  2. Service d’Hématologie, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Paris, France

    E Raffoux

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  1. K Burley
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Correspondence to K Burley.

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Burley, K., Wolf, J., Raffoux, E. et al. Long-term survival following post-allograft relapse of T-cell acute lymphoblastic leukaemia: a novel approach using nelarabine and donor lymphocyte infusions. Bone Marrow Transplant 53, 344–346 (2018). https://doi.org/10.1038/s41409-017-0038-8

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