Vol 11, No 1 (2020)
Case report
Published online: 2020-06-30

open access

Page views 813
Article views/downloads 201
Get Citation

Connect on Social Media

Connect on Social Media

The first allogeneic stem cell transplantation in Poland for a patient with refractory hairy cell leukemia

Mateusz Toborek1, Agata Wieczorkiewicz-Kabut1, Grażyna Semeńczuk2, Grzegorz Helbig1
Hematologia 2020;11(1):45-49.

Abstract

Introduction. Hairy cell leukemia (HCL) is an uncommon B-cell lymphoproliferative disorder characterized by distinctive cells present in bone marrow, peripheral blood and spleen. Treatment of relapsed and/or refractory (R/R) HCL remains a challenge. Case report. A 28-year-old male was treated with cladribine +/- rituximab for his newly diagnosed BRAF-V600 mutated HCL. A year later leukemia relapsed and he received interferon alfa with poor response. Subsequently, vemurafenib was continued for 5 months but this treatment also failed. Then, he received bendamustine with rituximab but significant response was not achieved. Finally, he was found eligible for allogeneic stem cell transplantation (Allo-SCT) from a 9/10-matched unrelated donor. He was conditioned with total body irradiation (TBI) and cyclophosphamide. Cyclosporine and methotrexate were used as graft-versus-host prophylaxis (GVHD). He engrafted and achieved full donor chimerism. There were 0.4% of hairy cells in bone marrow sample by flow cytometry at discharge. 3 months after transplantation he developed neurological and psychiatric deficits which remained unexplained despite a detailed work-up. The symptoms partly resolved after steroids implementation. At the last contact, 14 months after transplantation he remained in complete remission and his neurological condition improved substantially. Conclusions. Allo-SCT seems to be a promising treatment option for R/R HCL.

Article available in PDF format

View PDF Download PDF file

References

  1. Jain P, Pemmaraju N, Ravandi F. Update on the biology and treatment options for hairy cell leukemia. Curr Treat Options Oncol. 2014; 15(2): 187–209.
  2. Teras LR, DeSantis CE, Cerhan JR, et al. 2016 US lymphoid malignancy statistics by World Health Organization subtypes. CA Cancer J Clin. 2016; 66(6): 443–459.
  3. Troussard X, Cornet E. Hairy cell leukemia 2018: update on diagnosis, risk-stratification, and treatment. Am J Hematol. 2017; 92(12): 1382–1390.
  4. Kreitman RJ, Arons E. Update on hairy cell leukemia. Clin Adv Hematol Oncol. 2018; 16(3): 205–215.
  5. Forconi F, Sozzi E, Cencini E, et al. Hairy cell leukemias with unmutated IGHV genes define the minor subset refractory to single-agent cladribine and with more aggressive behavior. Blood. 2009; 114(21): 4696–4702.
  6. Maitre E, Cornet E, Troussard X. Hairy cell leukemia: 2020 update on diagnosis, risk stratification, and treatment. Am J Hematol. 2019; 94(12): 1413–1422.
  7. López-Rubio M, Garcia-Marco JA. Current and emerging treatment options for hairy cell leukemia. Onco Targets Ther. 2015; 8: 2147–2156.
  8. Dietrich S, Pircher A, Endris V, et al. BRAF inhibition in hairy cell leukemia with low-dose vemurafenib. Blood. 2016; 127(23): 2847–2855.
  9. Gerrie AS, Zypchen LN, Connors JM. Fludarabine and rituximab for relapsed or refractory hairy cell leukemia. Blood. 2012; 119(9): 1988–1991.
  10. Kreitman RJ, Dearden C, Zinzani PL, et al. Moxetumomab pasudotox in relapsed/refractory hairy cell leukemia. Leukemia. 2018; 32(8): 1768–1777.
  11. Nobre CF, Newman MJ, DeLisa A, et al. Moxetumomab pasudotox-tdfk for relapsed/refractory hairy cell leukemia: a review of clinical considerations. Cancer Chemother Pharmacol. 2019; 84(2): 255–263.
  12. Zinzani PL, Bonifazi F, Pellegrini C, et al. Hairy cell leukemia: allogeneic transplantation could be an optimal option in selected patients. Clin Lymphoma Myeloma Leuk. 2012; 12(4): 287–289.
  13. Kiyasu J, Shiratsuchi M, Ohtsuka R, et al. Achievement of complete remission of refractory hairy cell leukemia by rituximab progressing after allogeneic hematopoietic stem cell transplantation. Int J Hematol. 2009; 89(3): 403–405.
  14. Kreitman RJ, Stetler-Stevenson M, Wilson W, et al. Bendamustine and rituximab for the treatment of multiply relapsed hairy cell leukemia, Blood. 2011; 118(21): 3909–3909.
  15. Tiacci E, Park JH, De Carolis L, et al. Targeting mutant BRAF in relapsed or refractory hairy-cell leukemia. N Engl J Med. 2015; 373(18): 1733–1747.
  16. Cheever MA, Fefer A, Greenberg PD, et al. Treatment of hairy-cell leukemia with chemoradiotherapy and identical-twin bone-marrow transplantation. N Engl J Med. 1982; 307(8): 479–481.
  17. Thompson PA, Ravandi F. How I manage patients with hairy cell leukaemia. Br J Haematol. 2017; 177(4): 543–556.
  18. Grauer O, Wolff D, Bertz H, et al. Neurological manifestations of chronic graft-versus-host disease after allogeneic haematopoietic stem cell transplantation: report from the Consensus Conference on Clinical Practice in chronic graft-versus-host disease. Brain. 2010; 133(10): 2852–2865.



Hematology in Clinical Practice