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Neutropenia and febrile neutropenia following off-label use: case report A 56-year-old woman developed neutropenia and febrile neutropenia during off-label treatment with decitabine and venetoclax for T-cell lymphoblastic leukaemia (T-ALL) [routes not stated; not all outcomes stated]. The woman, whose medical history was notable for bilateral breast fibriadenoma, was admitted with severe dyspnoea. After subsequent examinations, she was diagnosed with T-ALL. She was treated with a pegaspargase containing regimen and achieved complete remission after the first cycle. She underwent the second and third cycles and was scheduled to undergo an allo-stem cell transplant (allo-SCT). Histological examinations showed infiltrating ductal carcinoma. Her ALL treatment was continued, along with intercalating administration of trastuzumab and radiotherapy. Her allo-SCT was confirmed, however, she developed a sudden haematological relapse 2 weeks after the radiotherapy. Hence, salvage off-label therapy with decitabine 20mg/m2 for 5 days every 28 days, along with venetoclax 400mg daily after a rump-up of 6 days (initial dose 100mg) was initiated. She did not experience tumour lysis syndrome; however, she developed treatment-related grade 4 neutropenia. At the time, posaconazole was added to her treatment for anti-fungal prophylaxis. The woman’s venetoclax dose was reduced to 200mg. During the second cycle, she experienced treatment-related febrile neutropenia, and venetoclax was temporarily held till neutrophil counts recovered. On day 28 of treatment, morphological complete remission was noted. She continued receiving venetoclax only until 1 week preceding the all-SCT. She was noted to be in complete remission at a follow-up 3 months post-transplant. A synergistic effect of decitabine and venetoclax was thought to contribute in the beneficial effects of the therapy in T-ALL. Zappone E, et al. Venetoclax in association with decitabine as effective bridge to transplant in a case of relapsed early T-cell lymphoblastic leukemia. Clinical Case Reports 8: 803514698 2000-2002, No. 10, Oct 2020. Available from: URL: http://doi.org/10.1002/ccr3.3041

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