title: PEITC in End-Stage B-Cell Prolymphocytic Leukemia: Case Report of Possible Sensitization to Salvage R-CHOP.
abstract: BACKGROUND
  B-cell prolymphocytic leukemia (B-PLL) is a rare, aggressive leukemia distinct from chronic lymphocytic leukemia, with median survival of only 3 years. B-PLL is resistant to most chemotherapy and newer targeted therapies such as alemtuzumab and thalidomide. Phenylethyl isothiocyanate (PEITC) is a natural compound from horseradish with evidence for therapeutic potential in multiple leukemia types.
  
  
  METHODS
  Here we present a case report of a 53-year-old man whose chronic lymphocytic leukemia transformed to end-stage B-PLL, disqualifying him for allogenic stem cell transplantation. He was treated with PEITC followed by salvage R-CHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin [doxorubicin hydrochloride], Oncovin [vincristine sulfate], Prednisone or Prednisolone) chemotherapy, which led to normalized white blood cell count and disease stabilization that requalified him for allogenic peripheral stem-cell transplant therapy. We conducted a systematic review to analyze and interpret the potential contribution of PEITC to his unexpectedly favorable R-CHOP response. Following sequential 8 weeks of PEITC/pentostatin and 6 cycles of R-CHOP, the patient received allogenic peripheral blood stem cell transplant on an outpatient basis and remains well at the time of this publication, with no evidence of CD20+ small B-cells.
  
  
  CONCLUSIONS
  Given the limited data for R-CHOP in B-PLL, this patient's recovery suggests presensitization of B-PLL cells toward R-CHOP, potentially justifying further investigation.
authors.affiliation: Physician Lead for Integrative Medicine at Walnut Creek Hospital in CA. arian.nachat@kp.org.
authors.forename: Arian
authors.initials: A
authors.lastname: Nachat
authors.affiliation: Research Associate in Integrative Medicine at Walnut Creek Hospital in CA. samturoff@gmail.com.
authors.forename: Sam
authors.initials: S
authors.lastname: Turoff-Ortmeyer
authors.affiliation: Medical Oncologist at Walnut Creek Hospital in CA. chunnan.liu@kp.org.
authors.forename: Chunnan
authors.initials: C
authors.lastname: Liu
authors.affiliation: Chief of Research for Integrative Medicine at the Pine Street Foundation in San Anselmo and at Walnut Creek Hospital in CA. michael.f.mcculloch@kp.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Mcculloch
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D006801:Humans; D017879:Isothiocyanates / Q000008:administration & dosage*; D054403:Leukemia, Prolymphocytic, B-Cell / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016879:Salvage Therapy
chemical_list: D017879:Isothiocyanates; C058305:phenethyl isothiocyanate