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Treatment failure in leptomeningeal T-cell prolymphocytic leukaemia: case report A 59-year-old woman exhibited treatment failure with methotrexate, hydrocortisone and cytarabine for leptomeningeal T-cell prolymphocytic leukaemia (T-PLL) [not all routes stated]. The woman, who was diagnosed with T-PLL at the age of 56 years, developed headaches with muffled hearing three years after diagnosis in August 2017 at the age of 59 years. Imaging studies confirmed leptomeningeal T-PLL. She received one dose of intrathecal cytarabine 100mg, two doses of combined intrathecal cytarabine 100mg and hydrocortisone 50mg twice weekly and four doses of combined intrathecal methotrexate 15mg, hydrocortisone 50mg and cytarabine 40mg twice weekly; however, no resolution of symptoms or disease was noted. She also received whole-brain radiation therapy in September 2017. After the radiation therapy, she started receiving off label treatment with IV alemtuzumab three times weekly on 6 October 2017. Bone marrow aspiration and biopsy two months following systemic therapy in December 2017, showed no evidence of disease, however her lumbar puncture showed persistent T-PLL with nausea and progressive headaches. She further received offlabel treatment with intrathecal alemtuzumab 1mg injection as per Innovative Care Policy guidelines. Following the first two injections, resolution of disease and symptoms was noted. The dose was increased to 3mg twice weekly (6 doses). It was transitioned to intrathecal alemtuzumab weekly dose along with IV alemtuzumab three times weekly. Afterwards, she underwent a matched-unrelated donor allogeneic hematopoietic stem cell transplant. She remained asymptomatic 18 months following the initiation of intrathecal alemtuzumab. Alsawah F, et al. Intrathecal alemtuzumab: a potential treatment of refractory leptomeningeal T-cell prolymphocytic leukemia. Blood Advances 3: 3333-3336, No. 21, 12 Nov 2019. Available from: URL: http://doi.org/10.1182/bloodadvances.2019000289 803504132

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Reactions 3 Oct 2020 No. 1824