Treatment of a child with myeloid/NK cell precursor acute leukemia with L-asparaginase and unrelated cord blood transplantation.
A 2-year-old Japanese boy who presented with multiple cervical, axillary, and inguinal lymphadenopathy was diagnosed by immunocytochemical analysis as having myeloid/natural killer (NK) cell precursor acute leukemia. Leukemic blasts in the bone marrow were positive for CD56 (NK marker), CD7 (T-cell marker), CD33 (myeloid marker), CD34, and HLA-DR. Tumor cells in a lymph node were also positive for CD2, cytoplasmic CD3 (T-cell marker), CD7, CD33, CD34, and CD56, but negative for peroxidase staining and other T-cell, NK, and myeloid markers. Southern blot analysis showed no rearrangement bands for T-cell receptor delta and immunoglobulin heavy chain. Chromosomal analysis revealed 46,XY,inv(7)(p21q21). Neither chemotherapy for acute lymphoblastic leukemia nor that for acute myeloid leukemia induced remission in this patient. However, complete remission was achieved by the administration of L-asparaginase (6,000 U/m2 for 5 days). Because the disease was considered refractory to standard chemotherapy, cord blood transplantation was performed from an HLA 1-locus mis-matched unrelated donor. The conditioning regimen consisted of total body irradiation, cytarabine, and cyclophosphamide, and cyclosporine and short-term methotrexate were employed for graft-versus-host disease (GVHD) prophylaxis. Hematological reconstitution was rapid, and only grade I acute GVHD was observed. The patient has been in remission for more than 24 months after transplantation. Our findings indicate that combination therapy with L-asparaginase and allogeneic stem cell transplantation may be useful for the treatment of myeloid/NK cell precursor acute leukemia.
Tezuka
Kayo
K
Division of Pediatrics, Hamanomachi Hospital, School of Medicine, Fukuoka University, Japan.
Nakayama
Hideki
H
Honda
Keiko
K
Suzumiya
Junji
J
Oshima
Kouichi
K
Kitoh
Toshiyuki
T
Ishii
Eiichi
E
D000208:Acute Disease; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001215:Asparaginase / Q000008:administration & dosage*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005312:Fetal Blood; D006801:Humans; D007694:Killer Cells, Natural / Q000187:drug effects / Q000473:pathology*; D007951:Leukemia, Myeloid / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D008297:Male; D012074:Remission Induction; D033581:Stem Cell Transplantation
D000970:Antineoplastic Agents; D001215:Asparaginase