Treatment of T-Cell Prolymphocytic Leukemia with Central Nervous System Involvement Using Intrathecal Alemtuzumab Administration

T-cell prolymphocytic leukemia (T-PLL) is a rare hematologic cancer with a dismal prognosis. Although a small number of patients have central nervous system (CNS) involvement, a standard treatment approach for these patients has not been established. Herein, we present a case of T-PLL with CNS invol...

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Published inCase reports in hematology Vol. 2020; no. 2020; pp. 1 - 4
Main Authors Ikezoe, Takayuki, Kimura, Satoshi, Oshima, Kumi, Mori, Jinichi
Format Journal Article
LanguageEnglish
Published Cairo, Egypt Hindawi Publishing Corporation 27.07.2020
Hindawi
Hindawi Limited
Wiley
Subjects
Antibodies
Blood
Case Report
Case reports
Cytotoxicity
Hematology
Immunotherapy
Leukemia
Lymphocytes
Lymphoma
Medical prognosis
Monoclonal antibodies
Nervous system
Patients
Stem cells
Targeted cancer therapy
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Summary:T-cell prolymphocytic leukemia (T-PLL) is a rare hematologic cancer with a dismal prognosis. Although a small number of patients have central nervous system (CNS) involvement, a standard treatment approach for these patients has not been established. Herein, we present a case of T-PLL with CNS involvement that was treated with a higher dose of intrathecal alemtuzumab than that previously reported. A 66-year-old man who had T-PLL with CNS involvement was admitted to our hospital. Intravenously administered alemtuzumab, a monoclonal antibody against the CD52 antigen, successfully reduced leukemia cells in peripheral blood; however, intrathecal treatment with methotrexate, cytarabine, and prednisone had a limited effect on the CNS involvement. Therefore, we intrathecally injected alemtuzumab as an experimental treatment. Although we escalated the dose of intrathecal alemtuzumab up to 5 mg, no adverse reaction was noted; however, this treatment did not completely clear the leukemia cells from the patient’s cerebrospinal fluid (CSF). We performed whole brain and whole spinal irradiation therapies and subsequently performed allogeneic transplantation from a human leukocyte antigen-matched sibling donor with a conditioning regimen containing total body irradiation. At 21 days after transplantation, leukemia cells remained in his CSF. Although intrathecal alemtuzumab did not eliminate the CNS-invading leukemia cells, it was well-tolerated in our case. Further accumulation of similar cases is needed to determine the benefits and safety of intrathecal alemtuzumab administration.
Bibliography:Academic Editor: Vincent Ribrag
ISSN:2090-6560
2090-6579
DOI:10.1155/2020/8822172