Successful Use of Nilotinib in the Therapy of a Patient with a Chemoresistant Relapse of BCR-ABL1-Like Phenotype Acute Lymphoblastic Leukemia.

Abstract

INTRODUCTION:

Relapse of acute lymphoblastic leukemia (ALL) after allogeneic hematopoietic cell transplantation (HCT) is a therapeutic challenge. We present the case of a 20-year-old patient with a relapse of Philadelphia chromosome-negative ALL B-common over 2 years after HCT with no response to salvage chemotherapy or blinatumomab, who finally responded to a molecularly tailored therapy adjusted to the BCR-ABL1-like phenotype.

METHODS:

The BCR-ABL1-like phenotype was diagnosed on the basis of an increased expression of ABL1 and CRLF2 genes.

RESULTS:

We combined a nilotinib-based therapy targeting the overexpressed ABL1 gene with a proteasome inhibitor and Peg-asparaginase, achieving a spectacular response: the percentage of lymphoblasts in the bone marrow was reduced from 70% to 5%, which enabled a second HCT to be performed. Moreover, the relatively low toxicity of the treatment led to a good quality of life and no need for prolonged hospitalization.

CONCLUSION:

To our knowledge, this is the first successful use of nilotinib in BCR-ABL1-like phenotype ALL. This case should encourage routine clinical use of molecular data to individualize therapies targeting the overexpressed pathways responsible for leukemic cell proliferation, as a means to overcome chemoresistance.

• Authors: Agnieszka Piekarska, Alicja Sadowska-Klasa, Marta Libura, Karolina Karabin, Andrzej Hellmann
• Journal: Oncology research and treatment (Oncol Res Treat) Vol. 41 Issue 9 Pg. 550-553 ( 2018) ISSN: 2296-5262 [Electronic] Switzerland
• PMID: 30121665 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2018 S. Karger GmbH, Freiburg.

Chemical References

• Antibodies, Bispecific
• CRLF2 protein, human
• Pyrimidines
• Receptors, Cytokine
• Polyethylene Glycols
• blinatumomab
• Bortezomib
• pegaspargase
• ABL1 protein, human
• Proto-Oncogene Proteins c-abl
• Asparaginase
• nilotinib

Topics

• Adult
• Antibodies, Bispecific (pharmacology, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (pharmacology, therapeutic use)
• Asparaginase (pharmacology, therapeutic use)
• Bortezomib (pharmacology, therapeutic use)
• Drug Resistance, Neoplasm
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Neoplasm Recurrence, Local
• Phenotype
• Polyethylene Glycols (pharmacology, therapeutic use)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (pathology, therapy)
• Proto-Oncogene Proteins c-abl (metabolism)
• Pyrimidines (pharmacology, therapeutic use)
• Receptors, Cytokine (metabolism)
• Salvage Therapy (methods)
• Treatment Outcome
• Young Adult