Successful treatment of two cases with Philadelphia-chromosome positive acute lymphoblastic leukemia who relapsed after allogeneic stem cell transplantation and the treatments with novel immunotherapies and ponatinib

Successful treatment of two cases with Philadelphia-chromosome positive acute lymphoblastic leukemia who relapsed after allogeneic stem cell transplantation and the treatments with novel immunotherapies and ponatinib

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The outcomes of relapsed Philadelphia chromosome-positive acute lorenametaute.com lymphoblastic leukemia (Ph+ALL) resistant to new drugs such as tyrosine kinase inhibitors, inotuzumab ozogamicin (InO) and blinatumomab are dismal.We treated two cases of Ph+ALL resistant to these drugs that achieved long-term survival after treatment with chimeric antigen receptor (CAR)-T cell therapy or a second allogeneic hematopoietic stem cell transplantation (HCT) with a sequential conditioning regimen.Case 1: A 15-year-old boy was diagnosed with Ph+ALL.

Despite the second HCT after the treatment of ponatinib and blinatumomab, hematological relapse occurred.InO was ineffective and he was transferred to a CAR-T center.After the CAR-T cell 12n/1200 wella therapy, negative measurable residual disease (MRD) was achieved and maintained for 38 months without maintenance therapy.

Case 2: A 21-year-old man was diagnosed with Ph+ALL.Hematological relapse occurred after the first HCT.Despite of the treatment with InO, ponatinib, and blinatumomab, hematological remission was not achieved.

The second HCT was performed using a sequential conditioning regimen with clofarabine.Negative MRD was subsequently achieved and maintained for 42 months without maintenance therapy.These strategies are suggestive and helpful to treat Ph+ALL resistant to multiple immunotherapies.