Successful treatment of hepatosplenic T-cell lymphoma with fludarabine, high-dose cytarabine and subsequent unrelated umbilical cord blood transplantation

Int J Hematol. 2022 Jan;115(1):140-145. doi: 10.1007/s12185-021-03229-0. Epub 2021 Sep 30.

Abstract

Hepatosplenic T-cell lymphoma (HSTCL) is a rare subtype of peripheral T-cell lymphoma that occurs most often in adolescents and young adults and is rare in children. Because of the aggressive clinical course, resistance to conventional chemotherapy and poor prognosis of HSTCL, an effective treatment has not been established. We report the case of a 3-year-old girl with HSTCL presenting with trilineage myelodysplasia. Although the HSTCL was refractory to conventional chemotherapy, remission was achieved with salvage chemotherapy that included fludarabine and cytarabine, which were shown to be effective in the drug sensitivity assay. After undergoing umbilical cord blood transplantation with a conditioning regimen consisting of etoposide, cyclophosphamide and total body irradiation, the patient has remained in complete remission for 8 years. Single-nucleotide polymorphism array analysis revealed heterozygous deletions of PAX5 (9p), ETV6 (12p) and homozygous deletions of CDKN2A (9p). Exome analysis showed a heterozygous nonsense c.2961C>G (p.Tyr987Ter) variant of the KMT2C gene. To improve the poor prognosis of HSTCL, the chemotherapeutic regimen can be selected for each patient on the basis of drug sensitivity and molecular genetic characteristics.

Keywords: Drug sensitivity assay; Hepatosplenic T-cell lymphoma; Purine metabolite antagonists.

Publication types

  • Case Reports

MeSH terms

  • Child, Preschool
  • Cord Blood Stem Cell Transplantation*
  • Cyclin-Dependent Kinase Inhibitor p16 / genetics
  • Cyclophosphamide / administration & dosage
  • Cytarabine / administration & dosage*
  • DNA-Binding Proteins / genetics
  • ETS Translocation Variant 6 Protein
  • Etoposide / administration & dosage
  • Female
  • Gene Deletion
  • Humans
  • Liver Neoplasms / genetics
  • Liver Neoplasms / therapy*
  • Lymphoma, T-Cell / genetics
  • Lymphoma, T-Cell / therapy*
  • PAX5 Transcription Factor / genetics
  • Prognosis
  • Proto-Oncogene Proteins c-ets / genetics
  • Remission Induction
  • Repressor Proteins / genetics
  • Splenic Neoplasms / genetics
  • Splenic Neoplasms / therapy*
  • Transplantation Conditioning / methods
  • Treatment Outcome
  • Vidarabine / administration & dosage
  • Vidarabine / analogs & derivatives*
  • Whole-Body Irradiation

Substances

  • CDKN2A protein, human
  • Cyclin-Dependent Kinase Inhibitor p16
  • DNA-Binding Proteins
  • KMT2C protein, human
  • PAX5 Transcription Factor
  • PAX5 protein, human
  • Proto-Oncogene Proteins c-ets
  • Repressor Proteins
  • Cytarabine
  • Etoposide
  • Cyclophosphamide
  • Vidarabine
  • fludarabine