Leukemia

Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia
 

I found 2 cases of infections resulting in remission!!! 

 

Case 1:
 

Dasatinib monotherapy for newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia with pulmonary infection in induction remission: A case report and review of the literature
 

"Patient concerns: A 59-year-old man who was newly diagnosed PH ALL with 93% blast cells and a t (9, 22) karyotype. But the patient also suffered from pulmonary infection, including fever and dyspnea...

Diagnoses: The patient was newly diagnosed with Ph ALL with pulmonary infection.

Interventions: The patient received oral dasatinib* [targeted therapy for PH ALL] monotherapy (100 mg qd) for 28 days as induction therapy.

Outcomes: The patient reached complete remission with negative minimal residual disease detected by real-time quantitative polymerase chain reaction after induction therapy for 28 days."
 

Case 2:

A Case of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia with Aspergillus Brain Abscess and Invasive Pulmonary Aspergillosis Successfully Treated with Voriconazole Followed by Cord Blood Transplantation

"A 59-year-old female was diagnosed as [invasive] pulmonary aspergillosis (IPA) while remission induction therapy** for Philadelphia chromosome-positive acute lymphoblastic leukemia. Liposomal amphotericin B [antifungal medication] improved the fungal serodiagnostic markers, however, the IPA worsened. She also developed an Aspergillus brain abscess, which, while being undetectable on CT, was detected as multiple nodular lesions by MRI. A definitive diagnosis was made by polymerase chain reaction (PCR) of brain biopsy specimens. Voriconazole (VRCZ) was effective, and cord blood transplantation was performed. She has received VRCZ for a long time. There are no relapse of either the IPA or the Aspergillus brain abscess."


*Dasatinib is a kinase inhibitor. "It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps stop the spread of cancer cells." 
https://medlineplus.gov/druginfo/meds/a607063.html

**Remission induction therapy: "Induction treatment is also called remission induction therapy. The goal of induction treatment for acute myelogenous leukemia (AML) is to clear the blood and bone marrow of immature blood cells (called blast cells, or blasts) and bring about a complete remission, or complete response. This treatment is usually given over 1 week." 
https://www.cancer.ca/en/cancer-information/cancer-type/leukemia-acute-myelogenous-aml/treatment/induction/?region=on

Other case reports of healing...

Case Report - Relapse after Prolonged Remission in Philadelphia-Like Acute Lymphoblastic Leukemia

"We describe a case of late relapse of Philadelphia-like acute lymphoblastic leukemia. The patient relapsed several years from diagnosis and responded to second salvage treatment. The case highlights the open questions regarding management of Philadelphia-like acute lymphoblastic leukemia."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360594/

[A Case of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia Achieving Complete Molecular Response with Ponatinib Therapy despite the Development of Hemorrhagic Stroke during Remission Induction Chemotherapy]

A man in his late 50s had lumbago and thrombocytopenia. He was diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia(Ph plus ALL). Remission induction chemotherapy was initiated with JALSG Ph plus ALL 208 protocol, but cerebral infarction in the right occipital lobe developed on day 2 and, to make matters worse, was accompanied by hemorrhagic cerebral infarction in the left occipital lobe on day 9. We decided that chemotherapy with multiple drugs was difficult to continue, and it was stopped. After improvement of the general condition, dasatinib therapy was started on day 52. After about 5 months, Ph plus ALL relapsed. Although mild disorientation and visual field defects remained due to old cerebral infarction, organ function was maintained, and patient performance status(PS)was classified as 1. Introduction of ponatinib was considered feasible, and ponatinib was started from a dose of 15mg/day to prevent the occurrence of vaso- occlusive adverse events. It was gradually increased to 30mg /day and continued about 4 months without recurrence of cerebral infarction. Complete molecular response was achieved with ponatinib therapy. It was suggested that, in patients with Ph plus ALL with a history of cerebral infarction, ponatinib could be a treatment option under careful risk management.

https://pubmed.ncbi.nlm.nih.gov/31748496/

Case Report - Durable remission in a patient of mixed phenotype acute leukemia with Philadelphia chromosome-positive treated with nilotinib and lenalidomide

A 54-year-old Chinese male patient who complained of chest pain and fatigue for 20 days. Bone marrow aspirate examination revealed hypercellularity with 70% blast cells... Diagnosis: Philadelphia chromosome-positive mixed phenotype acute leukemia.

Interventions: After relapsed from routine chemotherapy plus imatinib, the therapy was switched to oral therapy with nilotinib and lenalidomide due to his feeble condition. Outcomes:He successfully achieved long survival after oral therapy with nilotinib and lenalidomide.