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Open Access Case report

Persistent complete molecular remission after nilotinib and graft-versus-leukemia effect in an acute lymphoblastic leukemia patient with cytogenetic relapse after allogeneic stem cell transplantation

Paul Farnsworth, David Ward and Vijay Reddy*

Author Affiliations

Florida Hospital Cancer Institute, University of Central Florida, 2501 N. Orange Avenue. Suite 581, Orlando, FL, 32804, USA

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Experimental Hematology & Oncology 2012, 1:29  doi:10.1186/2162-3619-1-29

Published: 17 September 2012

Abstract

We report the successful treatment and sustained molecular remission using single agent nilotinib in a relapsed Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia patient after allogeneic hematopoietic stem cell transplantation. Compared to previously published studies, this is the first report where a patient did not receive additional chemotherapy after relapse, nor did she receive donor lymphocyte infusions. With nilotinib, the patient reverted back to normal blood counts and 100% donor reconstitution by single tandem repeat (STR) chimerism analysis in the bone marrow and in peripheral blood, granulocytes, T and B-lymphocytes. This report also highlights the use of nilotinib in combination with extracorporeal photopheresis (ECP) for concomitant graft-versus-host disease. Our data suggests that ECP, together with nilotinib, did not adversely affect the overall Graft-versus-leukemia (GVL) effect.

Keywords:
Philadelphia chromosome positive acute lymphoblastic leukemia (PH + ALL); Nilotinib; Extracorporeal photopheresis (ECP); Graft-versus-host disease (GVHD); Graft-versus-leukemia effect (GVL); Hematopoietic stem cell transplantation (HSCT)