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

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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.

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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