Dai Hai-Ping, Yin Jia, Li Zheng, Yang Chun-Xiao, Cao Tin, Chen Ping, Zong Yun-Hui, Zhu Ming-Qing, Zhu Xia-Ming, Xiao Sheng, Wu De-Pei, Tang Xiao-Wen
National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
Front Oncol. 2020 Mar 20;10:359. doi: 10.3389/fonc.2020.00359. eCollection 2020.
Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) is associated with high rates of treatment failure and poor outcome. Activation of ABL/Src family kinases is found in ~10% of Ph-like ALL, which can be therapeutically targeted by tyrosine kinase inhibitors. LYN is a member of the ABL/Src-tyrosine kinase family. Somatic rearrangements are found in 5 cases of hematopoietic malignancies so far, although none of them were treated with tyrosine kinase inhibitors. A 6-year-old boy with relapsed B-ALL had no response to reinduction chemotherapy. He was then treated with the tyrosine kinase inhibitor dasatinib and achieved complete remission within 2 weeks. Haploidentical allogenic stem cell transplantation (allo-HSCT) was subsequently performed and maintenance therapy with dasatinib initiated 8 weeks post-transplantation. He has been in minimal residual disease negative remission for 10 months after allo-HSCT. His bone marrow karyotype showed a balanced translocation between chromosomes 8 and 17, leading to a fusion gene confirmed with sequencing. Although overexpression is described in many AML and B-ALL patients, intragenic rearrangement is a rare event. For the first time, we present evidence that dasatinib is effective in treating a pediatric B-ALL with fusion.
费城染色体样急性淋巴细胞白血病（Ph样ALL）与高治疗失败率和不良预后相关。约10%的Ph样ALL中发现ABL/Src家族激酶激活，酪氨酸激酶抑制剂可对其进行靶向治疗。LYN是ABL/Src酪氨酸激酶家族的成员。迄今为止，在5例造血系统恶性肿瘤中发现了体细胞重排，尽管这些患者均未接受酪氨酸激酶抑制剂治疗。一名复发性B-ALL的6岁男孩对再诱导化疗无反应。随后他接受了酪氨酸激酶抑制剂达沙替尼治疗，并在2周内实现完全缓解。随后进行了单倍体相合异基因干细胞移植（allo-HSCT），并在移植后8周开始用达沙替尼进行维持治疗。allo-HSCT后，他处于微小残留病阴性缓解状态已达10个月。他的骨髓核型显示8号和17号染色体之间存在平衡易位，测序证实存在融合基因。虽然在许多急性髓系白血病（AML）和B-ALL患者中描述了该基因的过表达，但基因内重排是罕见事件。我们首次提供证据表明，达沙替尼对治疗伴有融合基因的儿童B-ALL有效。
