Abstract
Patients with t(17;19) acute lymphoblastic leukemia (ALL) have a dismal prognosis even with the most intensive current therapies that include stem cell transplant. We present the case of a patient with t(17;19)(q22;p13) gene rearranged B-cell precursor ALL whose lymphoblasts were found to have significant in vitro sensitivity to dasatinib. The patient tolerated the addition of dasatinib with combination therapy and remained in remission for over nine months until his recurrence. Therefore, future studies will be needed to interrogate whether dasatinib has any therapeutic benefit in children with t(17;19) B-cell precursor ALL.
Highlights
Significant advances in outcomes for childhood leukemia have been made over the past half-century with cure rates approaching ninety percent [1]
The t(17;19)(q22;p13) gene rearrangement yields a fusion product E2A-HLF which encodes a chimeric transcription factor that consists of the transactivation domain of E2A linked to the bZIP DNA-binding and protein dimerization domain of hepatic leukemia factor, HLF [3,4]
Cytogenetic evaluation revealed a similar complex karyotyope with t(17;19); 45,Y,add(X)(p22.1),add(1)(p3?4),del(6)(q1?1.2q2?2),9,add(12)(q2?2),t(17;19)(q22;p13.3)[1]/46,XY[24]. His marrow lymphoblasts at relapse remained sensitive to dasatinib in our small molecule assay (Fig. 1B)
Summary
CASE REPORTSignificant advances in outcomes for childhood leukemia have been made over the past half-century with cure rates approaching ninety percent [1]. We recently developed an in vitro assay using a panel of small molecule inhibitors to identify patient specific targeted drugs. We employed this assay on the diagnostic marrow sample of a patient who presented to our institution with t(17;19) ALL.
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