Successful treatment of relapsed anaplastic large cell lymphoma with vinblastine monotherapy and allo‐HSCT with reduced intensity conditioning regimen

Abstract

Relapsed anaplastic large cell lymphoma (ALCL) is chemosensitive, but recurrence is common. Although vinblastine (VLB) monotherapy is an effective treatment for relapsed ALCL, the optimal treatment duration is unknown, and some patients experience further relapse after completing the treatment. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is also an effective treatment for relapsed ALCL, although transplant-related toxicity is a problem. Here, we report an 11-year-old patient with relapsed ALCL who underwent induction therapy with VLB monotherapy and achieved complete remission (CR) after 12 courses. CR was confirmed on positron emission tomography-computed tomography. The patient then underwent allo-HSCT with reduced intensity conditioning (fludarabine, melphalan, and low-dose total body irradiation). He developed grade II acute graft-versus-host disease (GVHD), which was successfully treated with methylprednisolone. There was no evidence of chronic GVHD. He has remained in CR without any complications for 19 months after allo-HSCT.

Crizotinib induces apoptosis and gene expression changes in ALK+ anaplastic large cell lymphoma cell lines; brentuximab synergizes and doxorubicin antagonizes

“…Vinblastine, often used in the treatment of Hodgkin lymphoma, is also a tubulin inhibitor that is effective in ALCL and sometimes utilized as salvage therapy for relapsed disease . It has not, however, demonstrated additional long‐term benefit when added to front‐line therapies .…”

“…8,9,27 Vinblastine, often used in the treatment of Hodgkin lymphoma, is also a tubulin inhibitor that is effective in ALCL and sometimes utilized as salvage therapy for relapsed disease. 18,28,29 It has not, however, demonstrated additional long-term benefit when added to front-line therapies. 17,21 Aurora kinase A is a mitotic checkpoint regulator that is frequently expressed in ALK+ ALCL and may provide a therapeutic target in ALCL.…”

Allogeneic hematopoietic cell transplant following crizotinib monotherapy for relapsed/refractory anaplastic large cell lymphoma

“…Due to presumed risk of relapse associated with mixed chimerism, our institution followed peripheral blood and/or bone marrow chimerism regularly and managed progressive mixed chimerism with aggressive immunotherapy including rapid withdrawal of immune suppression and DLI . The use of other RIC regimens such as fludarabine, melphalan, and low‐dose irradiation has been reported in small numbers to successfully cure heavily pretreated relapsed/refractory ALCL patients (prior to the advent of CRZ); however, serial chimerism results were not described . Regimen‐related causes for progressive mixed chimerism and significance of progressive mixed chimerism after HCT for ALCL necessitate further investigation.…”

Refractory Anaplastic Large Cell Lymphoma Rescued by the Combination of the Second-Generation ALK Inhibitor Brigatinib, High-dose Chemotherapy and Allogeneic Stem Cell Transplantation: A Case Report and Review of the Literature

“…This choice is particularly justifiable in patients with a history of MDD/MRD positivity on bone marrow or peripheral blood, because allogeneic HSCT allows the use of a tumor-free graft and exploits the graft versus lymphoma associated with donorversus-recipient alloreactivity [7]. The most used preparative conditioning regimens are myeloablative, with or without total body irradiation, while the use of reduced conditioning regimens (RIC) to contain transplant-related mortality is still a matter of investigation [2,6,23,24,[26][27][28]. In a series of 6 R/R ALCL patients who underwent allogeneic HSCT after obtaining a complete clinical and radiological remission with crizotinib monotherapy, 3 of 4 who were conditioned with a RIC presented mixed chimerism which required repeated donor lymphocyte infusions.…”