Sequential Kinase Inhibition (Idelalisib/Ibrutinib) Induces Clinical Remission in B-Cell Prolymphocytic Leukemia Harboring a 17p Deletion
B-cell prolymphocytic leukemia (B-PLL) is a rare lymphoid neoplasm with an aggressive clinical course. Treatment strategies for B-PLL remain to be established, and, until recently, alemtuzumab was the only effective therapeutic option in patients harboring 17p deletions. Herein, we describe, for the...
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| Format: | Article |
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Wiley
2017-01-01
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| Series: | Case Reports in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2017/8563218 |
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| author | H. Coelho M. Badior T. Melo |
| author_facet | H. Coelho M. Badior T. Melo |
| author_sort | H. Coelho |
| collection | DOAJ |
| description | B-cell prolymphocytic leukemia (B-PLL) is a rare lymphoid neoplasm with an aggressive clinical course. Treatment strategies for B-PLL remain to be established, and, until recently, alemtuzumab was the only effective therapeutic option in patients harboring 17p deletions. Herein, we describe, for the first time, a case of B-cell prolymphocytic leukemia harboring a 17p deletion in a 48-year-old man that was successfully treated sequentially with idelalisib-rituximab/ibrutinib followed by allogeneic hematopoietic stem cell transplant (allo-HSCT). After 5 months of therapy with idelalisib-rituximab, clinical remission was achieved, but the development of severe diarrhea led to its discontinuation. Subsequently, the patient was treated for 2 months with ibrutinib and the quality of the response was maintained with no severe adverse effects reported. A reduced-intensity conditioning allo-HSCT from a HLA-matched unrelated donor was performed, and, thereafter, the patient has been in complete remission for 10 months now. In conclusion, given the poor prognosis of B-PLL and the lack of effective treatment modalities, the findings here suggest that both ibrutinib and idelalisib should be considered as upfront therapy of B-PLL and as a bridge to allo-HSCT. |
| format | Article |
| id | doaj-art-af76b9007836441fac3022e6f8a8eef0 |
| institution | Kabale University |
| issn | 2090-6560 2090-6579 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hematology |
| spelling | doaj-art-af76b9007836441fac3022e6f8a8eef02025-02-03T06:42:01ZengWileyCase Reports in Hematology2090-65602090-65792017-01-01201710.1155/2017/85632188563218Sequential Kinase Inhibition (Idelalisib/Ibrutinib) Induces Clinical Remission in B-Cell Prolymphocytic Leukemia Harboring a 17p DeletionH. Coelho0M. Badior1T. Melo2Serviço de Hematologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova Gaia, PortugalServiço de Hematologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova Gaia, PortugalServiço de Hematologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova Gaia, PortugalB-cell prolymphocytic leukemia (B-PLL) is a rare lymphoid neoplasm with an aggressive clinical course. Treatment strategies for B-PLL remain to be established, and, until recently, alemtuzumab was the only effective therapeutic option in patients harboring 17p deletions. Herein, we describe, for the first time, a case of B-cell prolymphocytic leukemia harboring a 17p deletion in a 48-year-old man that was successfully treated sequentially with idelalisib-rituximab/ibrutinib followed by allogeneic hematopoietic stem cell transplant (allo-HSCT). After 5 months of therapy with idelalisib-rituximab, clinical remission was achieved, but the development of severe diarrhea led to its discontinuation. Subsequently, the patient was treated for 2 months with ibrutinib and the quality of the response was maintained with no severe adverse effects reported. A reduced-intensity conditioning allo-HSCT from a HLA-matched unrelated donor was performed, and, thereafter, the patient has been in complete remission for 10 months now. In conclusion, given the poor prognosis of B-PLL and the lack of effective treatment modalities, the findings here suggest that both ibrutinib and idelalisib should be considered as upfront therapy of B-PLL and as a bridge to allo-HSCT.http://dx.doi.org/10.1155/2017/8563218 |
| spellingShingle | H. Coelho M. Badior T. Melo Sequential Kinase Inhibition (Idelalisib/Ibrutinib) Induces Clinical Remission in B-Cell Prolymphocytic Leukemia Harboring a 17p Deletion Case Reports in Hematology |
| title | Sequential Kinase Inhibition (Idelalisib/Ibrutinib) Induces Clinical Remission in B-Cell Prolymphocytic Leukemia Harboring a 17p Deletion |
| title_full | Sequential Kinase Inhibition (Idelalisib/Ibrutinib) Induces Clinical Remission in B-Cell Prolymphocytic Leukemia Harboring a 17p Deletion |
| title_fullStr | Sequential Kinase Inhibition (Idelalisib/Ibrutinib) Induces Clinical Remission in B-Cell Prolymphocytic Leukemia Harboring a 17p Deletion |
| title_full_unstemmed | Sequential Kinase Inhibition (Idelalisib/Ibrutinib) Induces Clinical Remission in B-Cell Prolymphocytic Leukemia Harboring a 17p Deletion |
| title_short | Sequential Kinase Inhibition (Idelalisib/Ibrutinib) Induces Clinical Remission in B-Cell Prolymphocytic Leukemia Harboring a 17p Deletion |
| title_sort | sequential kinase inhibition idelalisib ibrutinib induces clinical remission in b cell prolymphocytic leukemia harboring a 17p deletion |
| url | http://dx.doi.org/10.1155/2017/8563218 |
| work_keys_str_mv | AT hcoelho sequentialkinaseinhibitionidelalisibibrutinibinducesclinicalremissioninbcellprolymphocyticleukemiaharboringa17pdeletion AT mbadior sequentialkinaseinhibitionidelalisibibrutinibinducesclinicalremissioninbcellprolymphocyticleukemiaharboringa17pdeletion AT tmelo sequentialkinaseinhibitionidelalisibibrutinibinducesclinicalremissioninbcellprolymphocyticleukemiaharboringa17pdeletion |