Complete Remission and Early Relapse of Refractory Plasma Cell Leukemia after Bortezomib Induction and Consolidation by HLA-Mismatched Unrelated Allogeneic Stem Cell Transplantation

2007 ◽  
Vol 30 (4) ◽  
pp. 193-195 ◽  
Author(s):  
William H. Krüger ◽  
Thomas Kiefer ◽  
Frank Schüler ◽  
Christian Lotze ◽  
Christoph Busemann ◽  
...  
Keyword(s):  
Stem Cell ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Plasma Cell ◽  
Allogeneic Stem Cell Transplantation ◽  
Plasma Cell Leukemia ◽  
Cell Leukemia ◽  
Early Relapse

scholarly journals Plasma Cell Leukemia in China: Retrospective Analysis of Clinical Characteristics and Prognosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5619-5619
Author(s):  
Tengteng Yu ◽  
Yan Xu ◽  
Gang An ◽  
Zengjun Li ◽  
Mu Hao ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
Retrospective Analysis ◽  
Cell Transplantation ◽  
Plasma Cell ◽  
Plasma Cell Leukemia ◽  
Cell Leukemia ◽  
Standard Chemotherapy

Abstract Background: Plasma cell leukemia (PCL) is an aggressive malignancy characterized by the presence of ≥ 20% plasma cells in the peripheral blood or an absolute plasma cell count >2× 109/L. PCL exists in two forms: primary PCL (PPCL) presents de novo, whereas secondary PCL (SPCL) defined as a leukemic transformation from a previously diagnosed MM. Materials and methods: We conducted a retrospective analysis in 46 cases with PCL patients enrolled in Blood Diseases Hospital, Chinese Academy of Medical Sciences from June 1997 to June 2016. Survival analysis and treatment response according to the response criteria of IMWG were analyzed to assess the efficacy of Bortezomib or Thalidomide based therapy combined with standard chemotherapy. Results: Median age of 46 cases was 54.5 years (29-72 years), 28 males and 18 females; primary PCL 20 cases, secondary PCL 26 cases. Among those, 20 cases with kappa type, while 22 λ cases, 4 cases no secretion. Renal dysfunction occurs 51.4% of patients, 69.6% with osteolytic changes. D-S stage: I 1 case, 2 cases of stage II, stage III 43 cases. Complex karyotypes accounted for 45.2%, high frequency of cytogenetic abnormalities occur in IgH / CCND1 rearrangement with 8 cases, 1q21 amplification in 8 cases, RB-1 abnormalities in 6 cases, 4 cases of 17p deletion and 1 IgH / MAF rearrangement . 36 patients were evaluated in treatment responses, the overall reaction (≥MR) was 97.2%; 7 cases acquired complete remission (CR), 14 near complete remission (nCR), 6 very good partial response (VGPR), 8 cases of partial remission (PR), 1 case loss response. 16 cases of Bortezomib based therapy combined with chemotherapy; while 18 patients were treated with thalidomide combined with chemotherapy, 2 cases were conducted with allogeneic stem cell transplantation, 2 patients with chemotherapy underwent autologous stem cell transplantation after standard chemotherapy. Mean Overall survival (OS) was 19 months; primary and secondary PCL median OS was 15 months and 22 months separately (P = 0.098); Thalidomide based regimens and bortezomib-based regimen acquired a median OS 15 months and 30 months (P = 0.083). Median time to progression (TTP) of thalidomide and bortezomib based therapy was 6 months and 25 months (P = 0.03). The overall median TTP was 9 months. Conclusions: Higher incidence in cytogenetic aberrations was observed in plasma cell leukemia. Combined chemotherapy with bortezomib can improve progression-free survival of patients, but cannot improve overall survival. Disclosures No relevant conflicts of interest to declare.

Rituximab Plus Donor Lymphocyte Infusion (DLI) to Prevent or Treat Relapse for B Cell Malignancies after Allogeneic Hematopoietic Stem Cell Transplantation (alloHSCT)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4304-4304
Author(s):  
Irene Cavattoni ◽  
Heike Schieder ◽  
Tatjana Zabelina ◽  
Ulrike Bacher ◽  
Francis Ayuk ◽  
...  
Keyword(s):  
Stem Cell ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
B Cell ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
B Cell Malignancies ◽  
Early Relapse ◽  
Alive With Disease

Abstract Dose-reduced conditioning followed by allogeneic stem cell transplantation (HSCT) is a potentially curative therapy in B non Hodgkin lymphomas (NHL). However, the number of patients who experienced an early relapse is significant, and the achievement of a prolonged second remission is usually a rare event. Posttransplant immunotherapy with DLI to induce graft versus lymphoma (GVL) effect is a reasonable option to prevent or treat relapse, however the risk of graft versus host disease (GvHD) is high. Since B-cells might serve as antigen presenting cells to induce GvHD, additional B-cell depleting therapy with monoclonal antibody (anti CD20) might reduce the risk of GvHD while inducing additional cytotoxicity to B-cells originating from B-cell lymphoma. In the current pilot study we investigated the feasibility of a combined rituximab (Rtx) plus DLI therapy in B-cell malignancies after allogeneic stem cell transplantation to prevent (n=10) or treat relapse (n=2). Twelve consecutive patients, 8 male and 4 female, affected by B cell malignancies and transplanted between July 2002 and February 2007, were included in this study. The median age at alloHSCT was 58 ys (range 27–64). The conditioning regimen consisted of melphalan (140 mg/m2), fludarabine (150 mg/m2) and ATG–Fresenius (30–60 mg/kg) (n=9) or busulfan (8–10 mg/kg), fludarabine (150 mg/kg) (n=3), donors were HLA identical sibling in the half of the group, with one HLA mismatched-unrelated donor. The source of stem cell was peripheral blood in all patients. Seven patients were not in disease remission at the time of HSCT. The indication of Rtx-DLI administration was prophylaxis of relapse in all but two patients. The schedule of this approach was: Rtx (375 mg/mq, in 4 consecutive weekly infusions), started at a median time of 194 dy from HSCT (range 77–895). DLI, in a single dose, was administered from a minimum of 1×105/Kg up to 5×106/Kg, after discontinuation of immuno-suppression, without signs of GvHD. Three patients developed acute GvHD after DLI, two with gastro-intestinal and one with cutaneous involvement, whereas 6/12 patients experienced chronic GvHD, limited in all but two. Two cases of bacterial and one case of Pneumocystis jirovecij pneumonia were diagnosed after the treatment, in 3 different patients. Two patients died in complete remission due to infectious complications. The median number of B-circulating lymphocytes before and after Rtx was 42/μL (range 0–477) and 4 (range 0–226) respectively, and the difference is not statistically significant in terms of incidence of infection in our group (χ2 test). After a median follow up of 21 mo (range 4–37) from the 1st Rtx infusion, 8/12 patients are alive at the last follow-up, six of them without disease, whereas 2 patients died due to progressive disease(table1). Rituximab and DLI post allogeneic HSCT seems to be a safe and effective approach to prevent early relapse in B malignancies in complete remission after allogeneic stem cell transplantation. Table 1 Pt no Indication of R-DLI Infection aGVHD cGVHD Relapse Last follow-up 1 prophylaxis pneumonia II (GI tract) n n alive in CR 2 prophylaxis n n n n alive in CR 3 prophylaxis n n n n alive in CR 4 prophylaxis n n n y alive with disease 5 prophylaxis n n lim n alive in CR 6 prophylaxis n n n n alive in CR 7 relapse n n lim y alive with disease 8 relapse n n n y dead with disease 9 prophylaxis PJP n ext n dead in CR 10 prophylaxis pneumonia n lim n dead in CR 11 prophylaxis n II (skin) lim y dead with disease 12 Prophylaxis N I (skin) ext n Alive in CR

scholarly journals Primary plasma cell leukemia and autologous stem cell transplantation

Haematologica ◽  
2010 ◽  
Vol 95 (5) ◽  
pp. 804-809 ◽  
Author(s):  
M. B. Drake ◽  
S. Iacobelli ◽  
A. van Biezen ◽  
C. Morris ◽  
J. F. Apperley ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Plasma Cell ◽  
Plasma Cell Leukemia ◽  
Cell Leukemia ◽  
Primary Plasma Cell Leukemia

scholarly journals Relapsed/refractory multiple myeloma-transformed plasma-cell leukemia successfully treated with daratumumab followed by autologous stem cell transplantation

2021 ◽  
Vol 12 ◽  
pp. 204062072198957
Author(s):  
Chen-lu Yang ◽  
Neng-gang Jiang ◽  
Li Zhang ◽  
Kai Shen ◽  
Yu Wu
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Plasma Cell ◽  
Immune Cell ◽  
Plasma Cell Leukemia ◽  
Cell Leukemia ◽  
Hematopoietic Stem ◽  
Refractory Multiple Myeloma

Daratumumab is a humanized anti-CD38 IgG1 monoclonal antibody which could be used for multiple myeloma (MM). MM with plasma-cell leukemia (PCL) transformation is highly aggressive and is resistant to conventional therapy. Novel therapeutics are needed for PCL, and daratumumab may play role. We report a case of relapsed/refractory multiple myeloma (RRMM)-transformed PCL successfully treated with daratumumab. The case was a 42-year-old man who was diagnosed with MM 2 years ago and relapsed after six cycles of bortezomib-based chemotherapy. The patient rapidly developed hyperleukocytosis and disseminated intravascular coagulation, and was diagnosed with PCL. Daratumumab-based therapy was tried and the case miraculously obtained complete remission (CR) after four doses of a weekly infusion of daratumumab. Finally the patient received autologous hematopoietic stem-cell transplantation (auto-HSCT) and maintained CR. Moreover, we monitored the immune cell dynamics by flow cytometry (FCM) during daratumumab-based treatment. The immune cell subset analysis revealed significant down-regulation of CD38+ natural killer (NK) cells, regulatory T cells (Tregs) and regulatory B cells (Bregs). Meanwhile cytotoxic T-lymphocyte expansion was observed. In conclusion, daratumumab could rapidly decrease tumor burden, improve the condition of the PCL patient, and serve as a bridging salvage chemotherapy for further chimeric antigen recptor T cell therapy (Car-T) or HSCT, which could potentially improve patient survival. The immune cell dynamic findings in this case suggest that the immunomodulatory mechanism may contribute to the antimyeloma effect of daratumumab.

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