title: Haematological complete remission by ponatinib and bortezomib in a patient with relapsed, Ph⁺ pre-B acute lymphoblastic leukaemia.
abstract: A 74-year-old man was previously diagnosed with BCR-ABL1-positive pre-B cell acute lymphoblastic leukaemia (pre-B ALL) based on bone marrow cytology, flow cytometry, cytogenetics and fluorescent in situ hybridisation findings. Following a highly complicated hospital course, the patient achieved cytogenetic remission by consolidated chemotherapy and the tyrosine kinase inhibitor dasatinib. He subsequently presented with relapsed pre-B ALL after 3 years in remission. In consideration of his challenging clinical history, he was started on concurrent ponatinib (45 mg daily) and bortezomib (1.3 mg/m(2) intravenous weekly). The major molecular response was achieved (<0.0893% BCR-ABL1 transcripts) after 3 months. Bone marrow now demonstrates a BCR-ABL1-negative, complete cytogenetic response. The patient continues to do well with mild thrombocytopenia and improved anaemia on bortezomib and 30 mg daily ponatinib. Our experience with a single patient suggests the feasibility of combined targeted therapy with ponatinib and bortezomib. This novel treatment approach achieved clinical remission with a manageable toxicity profile.
authors.affiliation: Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Robinson
authors.forename: Yair
authors.initials: Y
authors.lastname: Levy
authors.forename: Christopher
authors.initials: C
authors.lastname: Maisel
authors.forename: Alex W
authors.initials: AW
authors.lastname: Tong
mesh_terms: D000208:Acute Disease; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage; D008297:Male; D010677:Philadelphia Chromosome; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000188:drug therapy* / Q000235:genetics; D011719:Pyrazines / Q000008:administration & dosage; D011724:Pyridazines / Q000008:administration & dosage; D012008:Recurrence; D012074:Remission Induction
chemical_list: D001897:Boronic Acids; D007093:Imidazoles; D011719:Pyrazines; D011724:Pyridazines; C545373:ponatinib; D000069286:Bortezomib
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