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Management of Patients With Relapsed T-Cell ALL
New York—At the 2019 Lymphoma & Myeloma congress, Pinkal Desai, MD, MPH, Assistant Professor of Medicine, Weill Cornell Medical College, New York, discussed the management of difficult cases of acute lymphoblastic leukemia (ALL), particularly relapsed T-cell disease.
“One of the most frustrating parts of ALL management is relapsed T-cell ALL,” Dr Desai told attendees.
“We have all of these agents in B-cell ALL, but for a patient with relapsed T-cell ALL we really are lost in terms of good options that these patients can get cured from their relapse with,” she continued.
According to Dr Desai, there are only 2 drugs approved by the FDA for the treatment of T-cell ALL.
“There’s nothing similar to the CD19 marker in B-cell disease, despite ongoing research seeking out genetic signatures in T-cell ALL that could have small molecular inhibition,” she said, adding that we are nowhere close to a therapy approval for this type of ALL at the moment.
Speaking specifically about the agents that are currently approved for relapsed T-cell disease, Dr Desai told listeners that they are nelarabine and liposomal vincristine.
Nelarabine has been shown to elicit complete responses in patients with relapsed disease, as well as some instances of long-term survival; however, as Dr Desai explained, the problem lies in that neurotoxins are common with nelarabine, occurring in approximately 70% of patients and leading to problems including numbness and tingling.
“This drug can be used, but not without toxicity, and patients have to be monitored very closely for developing signs of neurotoxicity,” she said.
Dr Desai concluded the session by telling attendees that liposomal vincristine could be considered in older patients with T-cell ALL, having shown an overall complete response rate of 20% in this patient population.—Hina Porcelli
