Chemo-free maintenance therapy in adult T-cell acute lymphoblastic leukemia: A case report and literature review

Abstract

Maintenance therapy in adult T-cell acute lymphoblastic leukemia (T-ALL) is the longest phase but with limited option. The classic drugs used in the maintenance phase such as 6-mercaptopurine, methotrexate, corticosteroid and vincristine have potentially serious toxicities. Optimizing therapy in the modern age, chemo-free maintenance therapy regimens for patients with T-ALL may dramatically improve the maintenance therapeutic landscape. We report here the combination of Anti-programmed cell death protein 1 antibody and histone deacetylase inhibitor as chemo-free maintenance treatment in a T-ALL patient with literature review, thus providing a unique perspective in addition to valuable information which may inform novel therapeutic approaches.

Current treatment strategies targeting histone deacetylase inhibitors in acute lymphocytic leukemia: a systematic review

“…Furthermore, a study reported that the combination of low-dose decitabine and chidamide enhanced apoptosis activation in adult ALL cases, particularly in patients with p16 deletion. This enhancement was achieved by regulating c heckpoint kinase 1 phosphorylation and γH2A.X expression ( 68 ).…”

“…The combination of SAHA and idarubicin is effective in pre-B-ALL, with HDAC2 implicated as a possible effector of synergism with SAHA ( 72 ). Chidamide plus chemotherapy is another strategy that has achieved better CR and ORR in patients with T-cell acute lymphoblastic lymphoma/leukemia (T-LBL/ALL) than chemotherapy alone ( 68 ). However, the underlying mechanism for this improvement remains unclear.…”

“…reported the first successful use of this combination strategy in the maintenance therapy of T-ALL. Bone marrow evaluation and minimal residual disease detection implied complete remission after the two-year term therapy ( 68 ). HDACi are also helpful in leukemia treatment after CAR-T cell therapy ( 87 , 88 ).…”