Zanubrutinib as upfront treatment in de-novo B-cell prolymphocytic leukemia: the case of two elderlies.
Main Article Content
Keywords
B-cell prolymphocytic leukemia, orphan-drug disease, Zanubrutinib, elderly
Abstract
B-cell prolymphocytic leukemia (B-PLL) is a rare lymphoproliferative disorder characterized by splenomegaly, lymphocytosis, and poor prognosis. Treatment options are limited, with modest responses to chemo-immunotherapy. We present two elderly patients with B-PLL treated with Zanubrutinib, a second-generation BTK inhibitor, achieving good disease response and tolerance. Both had TP53 deletion/mutations and high-risk complex karyotype. They obtained partial remission with normalization of hematologic parameters and spleen size. Given the rarity of the disease, further studies are needed to define treatment strategies, but Zanubrutinib appears to be a promising drug in this rare orphan drug disease.
Downloads
Abstract 55
PDF Downloads 22
Html Downloads 7
References
[1] Catovsky D, Galetto J, Okos A, et al. Prolymphocytic leukaemia of B and T cell type. Lancet 1973; 2: 232–234.
[2] Shvidel L, Shtalrid M, Bassous L, et al. B-Cell Prolymphocytic Leukemia: A Survey of 35 Patients Emphasizing Heterogeneity, Prognostic Factors and Evidence for a Group with an Indolent Course. Leukemia & Lymphoma 1999; 33: 169–179.
https://doi.org/10.3109/10428199909093739
[3] Alaggio R, Amador C, Anagnostopoulos I, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia 2022; 36: 1720–1748.
https://doi.org/10.1038/s41375-022-01620-2
[4] Campo E, Jaffe ES, Cook JR, et al. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood 2022; 140: 1229–1253.
https://doi.org/10.1182/blood.2022019016
[5] El Hussein S, Khoury JD, Medeiros LJ. B-prolymphocytic leukemia: Is it time to retire this entity? Annals of Diagnostic Pathology 2021; 54: 151790.
https://doi.org/10.1016/j.anndiagpath.2021.151790
[6] Chapiro E, Pramil E, Diop M, et al. Genetic characterization of B-cell prolymphocytic leukemia: a prognostic model involving MYC and TP53. Blood 2019; blood.2019001187.
https://doi.org/10.1182/blood.2019001187
[7] Lens D, J.J.C. De Schouwer P, Hamoudi RA, et al. p53 Abnormalities in B-Cell Prolymphocytic Leukemia. Blood 1997; 89: 2015–2023.
https://doi.org/10.1182/blood.V89.6.2015
[8] Mouhssine S, Maher N, Matti BF, et al. Targeting BTK in B Cell Malignancies: From Mode of Action to Resistance Mechanisms. IJMS 2024; 25: 3234.
https://doi.org/10.3390/ijms25063234
[9] Oka S, Ono K, Nohgawa M. Effective upfront treatment with low-dose ibrutinib for a patient with B cell prolymphocytic leukemia. Invest New Drugs 2020; 38: 1598–1600.
https://doi.org/10.1007/s10637-020-00902-9
[10] Jain A, Khunger J, Prasad P, et al. An illustrative case of B-cell prolymphocytic leukemia. Blood Res 2020; 55: 181–184.
https://doi.org/10.5045/br.2020.2020079
[11] Salvi F, Miller MD, Grilli A, et al. A Manual of Guidelines to Score the Modified Cumulative Illness Rating Scale and Its Validation in Acute Hospitalized Elderly Patients. J American Geriatrics Society 2008; 56: 1926–1931.
https://doi.org/10.1111/j.1532-5415.2008.01935.x
[12] Xing L, He Q, Xie L, et al. Zanubrutinib, rituximab and lenalidomide induces deep and durable remission in TP53-mutated B-cell prolymphocytic leukemia: a case report and literature review. haematol 2021; 107: 1226–1228.
https://doi.org/10.3324/haematol.2021.280259