Page 260 - Haematologica Vol. 107 - September 2022

LETTER TO THE EDITOR
for minimal residual disease. Of note, six of our patients relapsed on vinblastine or crizotinib. In this report of 11 CNS relapses treated with next-generation ALK inhibitors, a rapid, profound response was observed in all ten pa- tients. Only one patient experienced secondary progres- sion while on a next-generation ALK inhibitor whereas nine patients were still alive in complete remission at the last follow-up. Even though this series is small, the re- sponse rate and general outcome appears far better than that for relapsed/refractory ALK-positive ALCL with CNS involvement previously reported in the literature.3
The optimal duration of treatment with next-generation ALK inhibitors has not been assessed yet. Of note, al- though the majority of the patients achieved durable complete remissions, they may not be cured since abrupt relapses have been reported after the discontinuation of ALK inhibitors, even after several years of treatment.16 In this series, one patient is still in complete remission after having stopped his treatment with an ALK inhibitor for nearly 1 year, with no further treatment.
In conclusion, despite the small number of cases, this re- port suggests a promising activity of next generation ALK inhibitors in patients with ALK-positive ALCL and CNS in- volvement at relapse. It also suggests that we should be more careful regarding the CNS prophylaxis of high-risk and relapsed ALK-positive ALCL and next-generation ALK in- hibitors should be considered as part of CNS prophylaxis.
Authors
Charlotte Rigaud,1 Samuel Abbou,1 Stéphane Ducasso,2 Mathieu Simonin,3 Lou Le Mouel,4 Victor Pereira,5 Stéphanie Gourdon,6 Anne Lambilliotte,7 Birgit Geoerger,1 Véronique Minard-Colin1 and Laurence Brugières1
References
1. Lamant L, Meggetto F, al Saati T, et al. High incidence of the t(2;5)(p23;q35) translocation in anaplastic large cell lymphoma and its lack of detection in Hodgkin’s disease. Comparison of cytogenetic analysis, reverse transcriptase-polymerase chain reaction, and P-80 immunostaining. Blood. 1996;87(1):284-291.
2. Mussolin L, Le Deley M-C, Carraro E, et al. Prognostic factors in childhood anaplastic large cell lymphoma: long term results of the international ALCL99 trial. Cancers. 2020;12(10):E2747.
3. Del Baldo G, Abbas R, Woessmann W, et al. Neuro-meningeal relapse in anaplastic large-cell lymphoma: incidence, risk factors and prognosis – a report from the European Intergroup for Childhood Non-Hodgkin Lymphoma. Br J Haematol. 2021;192(6):1039-1048.
4. Mossé YP, Lim MS, Voss SD, et al. Safety and activity of crizotinib for paediatric patients with refractory solid tumours or anaplastic large-cell lymphoma: a Children’s Oncology Group
1Department of Children and Adolescents Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif; 2Department of Pediatric Oncology and Hematology, Bordeaux University Hospital, Bordeaux; 3Department of Pediatric Oncology and Hematology, Armand Trousseau Hospital- APHP, Paris; 4Department of Pediatric Hematology, Robert Debré Hospital- APHP, Paris; 5Department of Pediatric Oncology and Hematology, Besançon University Hospital, Besançon; 6Department of Pediatric Oncology and Hematology, Saint-Denis de la Réunion University Hospital, La Ré
union and 7Department of Pediatric Hematology, Lille University Hospital, Lille, France.
Correspondence:
CHARLOTTE RIGAUD - charlotte.rigaud@gustaveroussy.fr
https://doi.org/10.3324/haematol.2021.280081
Received: November 10, 2021. Accepted: May 11, 2022. Prepublished: May 19, 2022.
©2022 Ferrata Storti Foundation Published under a CC BY-NC license
Disclosures
No conflicts of interest to disclose.
Contributions
LB and CR planned the study. CR wrote the first draft of the manuscript. All the authors contributed to data control and to writing and revising the manuscript.
Data-sharing statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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