Page 257 - Haematologica Vol. 107 - September 2022

LETTER TO THE EDITOR
Table 1. Patients’ initial diagnosis and relapse characteristics.
Disease characteristics at diagnosis
Characteristics of CNS relapse treated with a next-generation ALK inhibitors
Patient (age at diagnosis in years)
Initial CNS status
Other clinical risk factors for CNS at diagnosis*
MDD/ early MRD status in frontline
Histological pattern (SC/LH component vs. common)
Time from EOT to first relapse (months)
Interval between initial diagnosis and CNS involvement (months )
Number of relapse/ progression (type)
Last treatment before CNS relapse
Peripheral blood MRD status on previous treatment line
Type of relapse
Type of CNS involvement
1 (16)
negative
no
positive/ positive
common
0.7
54
3, relapse
vinblastine
positive
systemic and CNS
CNS mass (CSF nd)
2 (6)
negative
leukemic presentation (blood circulating cells on cytologoly)
positive/ positive
SC/LH
on therapy
4.9
3, progression
vinblastine
positive
systemic (including uncontrolled leukemic form) and CNS
multiple CNS masses + CSF positive
3 (19)
positive
na
nd
common
on therapy
na
1, progression
radio- therapy
positive
systemic and CNS
CNS mass (CSF nd)
4 (11)
negative
biopsy of choroid plexus papilloma at treatment initiation.
positive/ positive
common
on therapy
4.1
1, relapse (on biopsy route while on vinblastine for recovery post CNS biopsy)
vinblastine
positive
CNS only
multiple CNS masses
5 (9)
negative
no
positive/ positive
SC/LH
2.1
10.1
1, relapse
ALCL99
negative at EOT with ALCL99
systemic and CNS
CSF positive only
6 (1.8)
negative
BM involvement (diagnosed on cytology)
positive/ positive
SC/LH
on therapy
1.6
1, relapse
ALCL99
positive
systemic (including BM) and CNS
CSF positive only
7 (11)
negative
no
positive/ positive
nd
on therapy
9
2, relapse
crizotinib
positive
CNS only
CNS mass + CSF positive
8 (13)
negative
no
positive/ positive
nd
1.5
5.8
1, relapse
ALCL99
positive at EOT with ALCL99
systemic and CNS
CSF positive only
9 (4)
negative
BM involvement (diagnosed on cytology), severe HLH
positive/ positive
SC/LH
1.9
15.8
2, relapse
crizotinib
positive
CNS only
CNS mass
10 (19)
negative
no
positive/ positive
SC/LH
0.6
14.8
2, relapse
crizotinib
positive
CNS only
multiple CNS masses + CSF positive
*Leukemic presentation, bone marrow involvement, central nervous system involvement at diagnosis. CNS: central nervous system; MDD: minimal disseminated disease; early MRD: early measurement (after one chemotherapy course) of minimal residual disease; SC: small cell component; LH: lymphohistiocytic component; EOT: end of treatment; CSF: cerebrospinal fluid; nd: not done; na: not applicable; BM: bone marrow; HLH: hemophagocytic lymphohistiocytosis.
mission, four patients were still on ALK inhibitors at the date of the last follow-up visit. The treatment had been discontinued in the other five patients for various reasons: one patient (#8) underwent allogeneic hematopoietic
stem cell transplantation after complete remission; one patient (#3) stopped ceritinib because of grade 3 toxicity and was switched to weekly vinblastine for 3 months and received no further treatment after vinblastine, with a fol-
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