Nachat Arian, Turoff-Ortmeyer Sam, Liu Chunnan, Mcculloch Michael
Physician Lead for Integrative Medicine at Walnut Creek Hospital in CA.
Research Associate in Integrative Medicine at Walnut Creek Hospital in CA.
Perm J. 2016 Spring;20(2):74-80. doi: 10.7812/TPP/15-153.
B-cell prolymphocytic leukemia (B-PLL) is a rare, aggressive leukemia distinct from chronic lymphocytic leukemia, with median survival of only 3 years. B-PLL is resistant to most chemotherapy and newer targeted therapies such as alemtuzumab and thalidomide. Phenylethyl isothiocyanate (PEITC) is a natural compound from horseradish with evidence for therapeutic potential in multiple leukemia types.
Here we present a case report of a 53-year-old man whose chronic lymphocytic leukemia transformed to end-stage B-PLL, disqualifying him for allogenic stem cell transplantation. He was treated with PEITC followed by salvage R-CHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin [doxorubicin hydrochloride], Oncovin [vincristine sulfate], Prednisone or Prednisolone) chemotherapy, which led to normalized white blood cell count and disease stabilization that requalified him for allogenic peripheral stem-cell transplant therapy. We conducted a systematic review to analyze and interpret the potential contribution of PEITC to his unexpectedly favorable R-CHOP response. Following sequential 8 weeks of PEITC/pentostatin and 6 cycles of R-CHOP, the patient received allogenic peripheral blood stem cell transplant on an outpatient basis and remains well at the time of this publication, with no evidence of CD20+ small B-cells.
Given the limited data for R-CHOP in B-PLL, this patient's recovery suggests presensitization of B-PLL cells toward R-CHOP, potentially justifying further investigation.
B 细胞原淋巴细胞白血病（B-PLL）是一种罕见的侵袭性白血病，与慢性淋巴细胞白血病不同，中位生存期仅为 3 年。B-PLL 对大多数化疗以及诸如阿仑单抗和沙利度胺等新型靶向治疗均耐药。异硫氰酸苯乙酯（PEITC）是一种来自辣根的天然化合物，有证据表明其在多种白血病类型中具有治疗潜力。
在此，我们报告一例 53 岁男性病例，其慢性淋巴细胞白血病转变为终末期 B-PLL，使其不符合异基因干细胞移植条件。他接受了 PEITC 治疗，随后进行挽救性 R-CHOP（利妥昔单抗、环磷酰胺、羟基柔红霉素[盐酸多柔比星]、长春新碱[硫酸长春新碱]、泼尼松或泼尼松龙）化疗，这导致白细胞计数恢复正常且疾病稳定，使他有资格接受异基因外周干细胞移植治疗。我们进行了一项系统综述，以分析和解释 PEITC 对其出人意料的良好 R-CHOP 反应的潜在作用。在连续 8 周接受 PEITC/喷司他丁治疗以及 6 个周期的 R-CHOP 治疗后，患者在门诊接受了异基因外周血干细胞移植，在本出版物发表时情况良好，没有 CD20+小 B 细胞的证据。
鉴于 R-CHOP 治疗 B-PLL 的数据有限，该患者的康复表明 B-PLL 细胞对 R-CHOP 存在预致敏现象，这可能为进一步研究提供依据。
