2023 Volume 60 Issue 3 Pages 214-219
A five-year-old boy with B-precursor acute lymphoblastic leukemia relapsed after early intensified therapy and was found to be positive for TCF3::HLF. The administration of blinatumomab (BLI) resulted in a second remission, but osteolytic lesions appeared in areas such as the skull and clavicle. While remission in the bone marrow continued, lymphoblastic cells were found in a computed tomography-guided clavicle biopsy stamp specimen, and the patient was diagnosed with a second relapse. Anti-CD19 chimeric antigen receptor T-cell (CD19-CAR-T) therapy was planned, and lymphocyte apheresis was promptly performed. Inotuzumab ozogamicin was ineffective as a bridging therapy, but chemotherapy based on vincristine, prednisolone, and L-asparaginase was effective, followed by CD19-CAR-T therapy. The bone marrow was in remission at two months after CD19-CAR-T administration when a related HLA half-matched peripheral blood stem cell transplantation was performed as a consolidation therapy. An evaluation of extramedullary lesions, including osteolytic lesions, was performed using whole-body magnetic resonance imaging, which was useful for evaluating temporal changes and detecting new lesions. BLI and CD19-CAR-T therapy were effective in controlling the disease in this case.
