Acute lymphoblastic leukemia with the t(17;19) translocation: hope has appeared! Multimodal immunotherapy in a 3-year-old child with refractory disease: a case report

Acute lymphoblastic leukemia (ALL) with translocation t(17;19)(q21-q22;p13) TCF3::HLF (E2A::HLF) accounts for less than 1% of childhood B-lineage ALL. Since the first description, patients this type ALL are stratified into high-risk group. The disease often has a unique clinical presentation disseminated intravascular coagulation and hypercalcemia, that uncommon in other types This is characterized by an extremely poor prognosis despite intensive treatment hematopoietic stem cell transplantation (HSCT) remission. In last decade, some new data on mechanisms leukemogenesis made it possible to come closer understanding reasons high refractoriness chemotherapeutic agents. Along reports effectiveness BCL-2 (venetoclax) Aurora kinase A (alisertib) inhibitors ALL, cellular immunotherapy (various chimeric antigen receptor (CAR)-T constructs), anti-CD19 (blinatumomab) anti-CD22 (inotuzumab ozogamicin) monoclonal antibodies appear promising disease. To date, there neither published direct comparisons these methods nor specific recommended therapy protocols patients. It also unclear if therapeutic approaches can completely replace HSCT or they only increase relapse-free survival after it. Here, we review medical literature present case report 3-year-old boy leukemia, who did not respond four-component induction according ALL-MB 2015 Protocol received CAR-T achievement MRD (minimal residual disease)-negative remission, which lasted 11 months. After MRD-relapse unsuccessful attempt at autologous CD19/CD22 cells, patient developed extended isolated bone marrow relapse. He achieved second MRD-negative remission reinduction inotuzumab ozogomycin allogeneic from related donor. At time writing, complete molecular 16 months transplantation. patient's parents have consented use de-identified information photos scientific research publications.