A child who underwent allogeneic bone marrow transplantation for late relapsed TCF3-ZNF384-positive B-cell precursor acute lymphoblastic leukemia

Abstract

We present the case of an 8-year-old girl diagnosed as having B-cell precursor acute lymphoblastic leukemia (BCP-ALL) at the age of 4 years. Her initial steroid response was good. The first remission was achieved after induction therapy and maintained with chemotherapy for 2.5 years. Bone marrow relapse occurred 4.5 years after the initial presentation and 2 years after therapy. A leukemia-related fusion gene test revealed TCF3-ZNF384 positivity. During second remission, bone marrow transplantation was performed from her HLA8/8 allele-matched father using a conditioning regimen (melphalan, 180 mg/m²; total-body irradiation, 12 Gy). Neutrophil recovery was achieved 17 days after transplantation, with no acute complications other than acute graft-versus-host disease of the skin. She remains disease-free one year after transplantation. The prognosis of recurrent TCF3-ZNF384-positive BCP-ALL is poor, and hematopoietic cell transplantation may provide good results. Although this patient achieved good results using a myeloablative conditioning regimen, the appropriate conditioning regimen intensity remains unclear, warranting future investigation.