ISSN 1866-8836
Клеточная терапия и трансплантация

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Clinical case

Successful treatment of extramedullary relapsed/refractory B-acute lymphoblastic leukemia with Inotuzumab ozogamicin before and after allogeneic stem cell transplantation

Anna G. Smirnova, Sergey N. Bondarenko, Ivan S. Moiseev, Inna V. Markova, Elena I. Darskaya, Irina K. Golubovskaya, Bella I. Ayubova, Elena V. Babenko, Ildar M. Barkhatov, Alexander L. Alyanskiy, Tatiana L. Gindina, Alexander D. Kulagin, Boris V. Afanasyev

Clinical case

Successful treatment of extramedullary relapsed/refractory B-acute lymphoblastic leukemia with Inotuzumab ozogamicin before and after allogeneic stem cell transplantation

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Anna G. Smirnova, Sergey N. Bondarenko, Ivan S. Moiseev, Inna V. Markova, Elena I. Darskaya, Irina K. Golubovskaya, Bella I. Ayubova, Elena V. Babenko, Ildar M. Barkhatov, Alexander L. Alyanskiy, Tatiana L. Gindina, Alexander D. Kulagin, Boris V. Afanasyev

Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Chair of Hematology, Transfusiology and Transplantology, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia

Recent advances in treatment of relapsed/refractory B-Acute Lymphoblastic Leukemia (R/R B-ALL) are associated with targeted immune therapies, such as Blinatumomab, Inotuzumab ozogamicin and CAR-T cells. Several clinical studies demonstrate superior complete remission (CR) and allogeneic stem cell transplantation (allo-HSCT) rates after Blinatumomab or Inotuzumab treatment compared to conventional chemotherapy with different toxicity profiles. However, treatment of extramedullar lesions was not addressed in these trials.

Case presentation

We report two R/R B-ALL patients with extramedullar involvement. Case 1. A woman, 31 years old with Philadelphia positive B-ALL, being in second relapse not responding to Blinotumomab. Clinical progression was observed, with involvement of bone marrow (BM), cervical, mandibular lymph nodes and breast lesions. Complete BM and extramedullary remission was achieved after Inotuzumab followed by allogeneic stem cell transplantation from a matched related donor was performed. Case 2. A 25 years-old young woman exhibited a BM relapse after unrelated stem cell transplantation. Remission was achieved after Blinotumomab treatment. Inotuzumab was administered for 6th extramedullary relapse. A complete metabolic response was achieved after 4 cycles of Inotuzumab as shown by PET scanning.

Conclusion

The present cases demonstrate an opportunity for Inotuzumab administration after Blinotumomab failure in case of extramedullary relapse before and after allo-HSCT.

Keywords

Allogeneic hematopoietic stem cell transplantation, B-Acute Lymphoblastic Leukemia, Blinotumomab, Inotuzumab ozogamicin, extramedullary relapse.