Page 69 - Haematologica Vol. 107 - September 2022

ARTICLE - Outcome of r/r B-ALL with extramedullary disease
S. Kayser et al.
treatment. One patient experienced a molecular relapse, which was successfully treated with INO again. Ten pa- tients are still in CR (n=9) or PR (n=1), including the patient with prior molecular relapse and re-exposure to INO. Our cohort also included three patients with central nerv- ous system involvement. The first patient initially devel- oped central nervous system relapse with positive cytology, but eventually progressed with an epidural mass treated with INO and ponatinib. This patient developed VOD after three INO cycles. Thus, all treatment was with- held. The cerebrospinal fluid remained intermittently posi- tive for ALL (treated with intrathecal chemotherapy), but the peripheral blood remained negative and the epidural mass has not recurred. The second patient was treated with six cycles of intrathecal methotrexate/cytarabine/dexa- methasone. The cerebrospinal fluid was negative after the second cycle and remained negative thereafter. The patient
also received four INO cycles and achieved CR without measurable residual disease after the second INO cycle. The patient went on to allogeneic HSCT, but relapsed 3.5 months later and died 8.2 months after relapse. Finally, in the last patient, central nervous system relapse was not confirmed (both cerebrospinal fluid evaluation and magnetic resonance imaging were equivocal), but sus- pected due to diplopia, which improved after high-dose methotrexate (given before INO). The patient was then switched to six INO cycles and achieved CR according to PET-CT after three INO cycles. Unfortunately, the patient developed systemic (blood/marrow/extramedullary) re- lapse 1.5 months later. Cerebrospinal fluid at that time was negative and there were additionally no suggestive central nervous systems symptoms (no recurrence of di- plopia or other neurological deficits). The patient died 13 days after relapse due to rapidly progressive disease.
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Figure 3. Overall survival of relapsed/refractory patients with B-acute lymphoblastic leukemia and extramedullary disease after treatment with Inotuzumab ozogamicin. Green and red dotted lines indicate upper and lower bounds of the 95% confidence interval.
Figure 4. Relapse-free survival of patients attaining com- plete remission. Green and red dotted lines indicate upper and lower bounds of the 95% confidence interval.