Complete Remission of a Refractory Acute Myeloid Leukemia with Myelodysplastic- and Monosomy 7-Related Changes after a Combined Conditioning Regimen of Plerixafor, Cytarabine and Melphalan in a 4-Year-Old Boy: A Case Report and Review of Literature

Cancers
Antonio G GrassoNatalia Maximova

Abstract

Acute myeloid leukemia with myelodysplastic changes and monosomy 7 is a rare form of pediatric leukemia associated with very poor disease-free survival. The refractoriness of the disease is due to the protection offered by the bone marrow niche, making leukemic stem cells impervious to whatever chemotherapy or myeloablative regimen is chosen. Using a mobilizing agent for haematopoietic stem cells, Plerixafor, could sensitise leukemic cells to the myeloablative therapy. This approach was not previously used in a pediatric population, and in adult populations, was used in combination with busulphan with no difference in overall survival. We describe the case of a 4-year-old boy affected by refractory acute myeloid leukemia with myelodysplastic changes and monosomy 7. The child had never achieved a remission. We proposed a combined time-scheduled scheme of therapy with plerixafor and melphalan. Combining pharmacokinetics of plerixafor with pharmacokinetics and rapid and elevated myeloablative potential of melphalan in high dosage (200 mg/m²), we succeeded in mobilizing more than 85% of stem blasts immediately before infusion of Melphalan. The count of residual blasts after 8 h from melphalan infusion was only 1.3 cells/μL. The chi...Continue Reading

References

Aug 1, 1996·Leukemia & Lymphoma·M HassanP Ljungman
Aug 2, 2001·Leukemia·Z HassanE Hellström-Lindberg
Dec 21, 2012·Pediatric Blood & Cancer·Alan S GamisUNKNOWN COG Acute Myeloid Leukemia Committee
Jan 11, 2013·Pediatric Blood & Cancer·Susan E PuumalaLogan G Spector
Jul 9, 2013·Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis·Fanny ChambonJustyna Kanold
Aug 19, 2014·Bone Marrow Transplantation·P J ShawH M Lazarus
Apr 30, 2015·Current Hematologic Malignancy Reports·Yoko Tabe, Marina Konopleva
Nov 2, 2015·Haematologica·Daniela S Krause, David T Scadden
Nov 12, 2015·Current Opinion in Hematology·Yavuz M Bilgin, Georgine E de Greef
Feb 3, 2016·Therapeutic Advances in Hematology·Armin Rashidi, John F DiPersio
Feb 24, 2018·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Musa AlzahraniSujaatha Narayanan

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Methods Mentioned

BETA
bone marrow aspiration
flow cytometry
biopsy

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