Contributions
Abstract: PB1646
Type: Publication Only
Background
At present, there is no consensus about how to treat infant with molecular relapse of Acute Lymphoblastic Leukemia (ALL) and t(4;11).“Watch and wait” strategy is the actual approach until evidence of hematological relapse for which there is no specific validate treatment.
Aims
We describe the case of a 2-year- and 6-month-old boy, with previous diagnosis (March 2016) of infant pro-B ALL, t(4;11) positive, treated according to the AIEOP INTERFANT 2006 Protocol. The patient resulted good prednisone responder on day +8. Minimal residual disease (MRD) was positive both on day +33 and +78. At the end of Induction, the MLL/AF4 rearrangement was negative. After Consolidation (MARMA cycle), MRD was still positive (Marker 1:<1x10-4; Marker 2:<1x10-4). According to protocol, the patient was not eligible for allogenic hematopoietic stem cell transplantation (HSCT) so, he continued therapy with Reiduction (OCTADAD); at the end of this cycle, MRD was still positive. On October 2016, the patient started Manteinance and MRD, at the first four controls resulted negative. On October 2017, it turned positive and MLL/AF4 rearrangement was again detected with negativity of Central nervous system (CNS). According to protocol, we had to monitor the disease course until a possible relapse. However, the new MRD positivity was pathognomonic of oncoming hematological relapse. The efficacy of Blinatumomab in MRD treatment of adult and pediatric ALL is well established. To avoid child’s hematological relapse, at very poor prognosis, and to ensure a treatment option that allow the successful of allogenic HSCT, compassionate use of Blinatumomab was purposed.
Methods
In December 2017, written informed consent was obtained and Blinatumomab was started at the dose of 5mcg/m2 daily for the first 7days of cycle 1. Then, the dose was increased to 15 mcg/m2 daily. To prevent neurological toxicity, prophylaxis with Levetiracetam was started. Two 28-days cycles of Blinatumomb were performed from December 2017 to February 2018. CNS prophylaxis was performed with 2 intrathecal administration of Methotrexate and Prednisone.
Results
MRD was already negative after 15 days of treatment, and remained negative until the end of the first cycle; at the same time, MLL/AF4 rearrangement resulted absent from day +15. The analysis of MRD and MLL/AF4 rearrangement persisted negative after the second cycle. The patient tolerated well the therapy, enjoying a good quality of life; the only side effect was fever during the first day of drug infusion. At the last clinical check, the child was in good general condition and shows no signs and/or symptoms of disease and he is waiting for allogenic HSCT.
Conclusion
In this case, the use of Blinatumomab alone allowed the patient to achieve complete molecular response. It is important to underline that, the child fastly obtained complete molecular remission with the use of immunotherapy without using chemotherapy. The use of Blinatumomab resulted active and well tolerated so, it was an excellent bridge to transplant. Blinatumomab in a molecular relapse of infant ALL could be an effective alternative to the current “watch and wait” strategy, whereas there is not specific validate treatment in case of hematological relapse.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, Immunotherapy
Abstract: PB1646
Type: Publication Only
Background
At present, there is no consensus about how to treat infant with molecular relapse of Acute Lymphoblastic Leukemia (ALL) and t(4;11).“Watch and wait” strategy is the actual approach until evidence of hematological relapse for which there is no specific validate treatment.
Aims
We describe the case of a 2-year- and 6-month-old boy, with previous diagnosis (March 2016) of infant pro-B ALL, t(4;11) positive, treated according to the AIEOP INTERFANT 2006 Protocol. The patient resulted good prednisone responder on day +8. Minimal residual disease (MRD) was positive both on day +33 and +78. At the end of Induction, the MLL/AF4 rearrangement was negative. After Consolidation (MARMA cycle), MRD was still positive (Marker 1:<1x10-4; Marker 2:<1x10-4). According to protocol, the patient was not eligible for allogenic hematopoietic stem cell transplantation (HSCT) so, he continued therapy with Reiduction (OCTADAD); at the end of this cycle, MRD was still positive. On October 2016, the patient started Manteinance and MRD, at the first four controls resulted negative. On October 2017, it turned positive and MLL/AF4 rearrangement was again detected with negativity of Central nervous system (CNS). According to protocol, we had to monitor the disease course until a possible relapse. However, the new MRD positivity was pathognomonic of oncoming hematological relapse. The efficacy of Blinatumomab in MRD treatment of adult and pediatric ALL is well established. To avoid child’s hematological relapse, at very poor prognosis, and to ensure a treatment option that allow the successful of allogenic HSCT, compassionate use of Blinatumomab was purposed.
Methods
In December 2017, written informed consent was obtained and Blinatumomab was started at the dose of 5mcg/m2 daily for the first 7days of cycle 1. Then, the dose was increased to 15 mcg/m2 daily. To prevent neurological toxicity, prophylaxis with Levetiracetam was started. Two 28-days cycles of Blinatumomb were performed from December 2017 to February 2018. CNS prophylaxis was performed with 2 intrathecal administration of Methotrexate and Prednisone.
Results
MRD was already negative after 15 days of treatment, and remained negative until the end of the first cycle; at the same time, MLL/AF4 rearrangement resulted absent from day +15. The analysis of MRD and MLL/AF4 rearrangement persisted negative after the second cycle. The patient tolerated well the therapy, enjoying a good quality of life; the only side effect was fever during the first day of drug infusion. At the last clinical check, the child was in good general condition and shows no signs and/or symptoms of disease and he is waiting for allogenic HSCT.
Conclusion
In this case, the use of Blinatumomab alone allowed the patient to achieve complete molecular response. It is important to underline that, the child fastly obtained complete molecular remission with the use of immunotherapy without using chemotherapy. The use of Blinatumomab resulted active and well tolerated so, it was an excellent bridge to transplant. Blinatumomab in a molecular relapse of infant ALL could be an effective alternative to the current “watch and wait” strategy, whereas there is not specific validate treatment in case of hematological relapse.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, Immunotherapy