Abstract
Adults with relapsed/refractory acute lymphoblastic leukemia have a poor prognosis. While current immunotherapies are promising, they are toxic, with graft-versus-host disease a major complication of allogeneic therapy. Here, we report a patient with high-risk relapsed/refractory Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia (ALL) following chemotherapy induction, matched related donor allogeneic hematopoietic stem cell transplantation (allo-HCT), donor lymphocyte infusion and two tyrosine kinase inhibitors. The patient achieved a complete molecular and cytogenetic remission with minimal adverse events or evidence of GVHD following recombinant human IL-2 (rIL-2), in combination with a tyrosine kinase inhibitor (TKI). There was a ninefold increase in natural killer (NK) cell activity and natural killer T cells (NKT) cells (CD2+CD26+). Personalized low dose recombinant human IL-2-mediated NK cell stimulation represents an effective, nontoxic immunotherapy administered in the outpatient setting for relapsed acute lymphoblastic leukemia and warrants further investigation.
Highlights
We report a case of complete molecular and cytogenetic remission in relapsed/refractory B-cell acute lymphoblastic leukemia (ALL) following allogeneic hematopoietic stem cell transplantation with personalized low-dose immunotherapy treatment using a recombinant human IL-2, aldesleukin
The recombinant human IL-2 (rIL-2) therapy was associated with minimal adverse events and no evidence of graft-versus-host disease. Personalized low-dose rIL-2 treatment with dosing and frequency tailored by measurement of a peripheral blood immune panel represents an immunotherapy modality that warrants further investigation given its efficacy and minimal side effects
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Summary
Dipnarine Maharaj*,1, Pedro Vianna, Gabriel DeCarvalho, Delaram Pourkalbassi, Christopher Hickey1 & Jacqueline Gouvea. We report a patient with high-risk relapsed/refractory Philadelphia chromosome-positive B-cell ALL following standard treatment and in whom a personalized immunotherapy treatment resulted in molecular remission with minimal side effects and maintenance of immune tolerance. This nontoxic treatment approach can be used to treat patients with relapsed/refractory ALL and needs to be evaluated in future research. The CD4+CD25+ regulatory T cells (Tregs) showed a progressive decrease This personalized treatment approach which targeted Ph+ acute lymphoblastic leukemia t (9; 22) resulted in molecular remission with minimal side effects
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