Treatment of T‐prolymphocytic leukemia with nonmyeloablative allogeneic stem cell transplantation

Abstract

Aim: T‐prolymphocytic leukemia (T‐PLL) is a rare disease of the elderly characterized by a high white blood cell count and organomegaly, and is currently incurable. Our aim was to elicit graft‐versus‐leukemia reactions in a patient with T‐PLL. Methods: A 52‐yr‐old woman with refractory T‐PLL underwent a nonmyeloablative regimen followed by allogeneic peripheral blood stem cell transplantation (a “minitransplant”) from her HLA‐matched sibling. Results: There was no treatment related toxicity other than neutropenia. Engraftment was successful. The patient experienced no graft‐versus‐host disease (GVHD) at any time but, on day 84 after transplantation, had a relapse in the central nervous system. Despite infusion of donor lymphocytes and intralumbar chemotherapy, she died on day 157 of systemic disease. Conclusion: The reasons why treatment may have failed are discussed (nature of disease, disease progression, treatment schedule).

Guidelines for the management of mature T‐cell and NK‐cell neoplasms (excluding cutaneous T‐cell lymphoma)

“…The 5-year survival rate was 34% for those patients who received a transplant compared to 0% for those who did not. Among other reports of allo-HSCT, (Collins et al, 1998;Garderet et al, 2001;Tanimoto et al, 2005;de Lavallade et al, 2006) the outcome appeared to be equally good following conventional and reduced intensity (RIC) conditioning. Considering the significantly greater toxicity of standard intensity Guideline conditioning, reduced intensity procedures would seem preferable in this group of patients.…”

Allogeneic Hematopoietic Cell Transplant for Prolymphocytic Leukemia

“…(12) Case reports also suggest the potential efficacy of allotransplants for PLL. (16-19) However, the efficacy of this approach remains uncertain. We, therefore, reviewed the databases of the Center for International Blood & Marrow Transplant Research (CIBMTR) to determine outcomes of allotransplants for PLL.…”

Emerging drugs for rarer chronic lymphoid leukemias

“…More recently, PNA and monoclonal antibodies (mAbs) have been introduced for the therapy of PLL [43][44][45] . At present, only high-dose chemotherapy, followed by allogenic stem cell transplantation (SCT), seems to be an effective and probably curative strategy for patients with PLL [46,47] .…”