Phase II Study of Nelarabine With Hyper-CVAD in Patients With Previously Untreated T cell Acute Lymphoblastic Leukemia (T-ALL) and Lymphoblastic Lymphoma (LL)

S368 Brief Abstract: Three patients with Ph+ALL underwent alloSCT without MMR before. All patients showed different degrees of MRD increase after transplant and were treated with 2nd generation TKIs, obtaining CMR. Full Abstract: Context. Dasatinib was active both in imatinib-resistant patients and as front-line treatment of Ph+ALL). Nilotinib showed activity in Ph+ALL in phase I studies. Few cases of successful therapy in Ph+ALL relapsing after BMT were reported. We report 3 cases of Ph+ALL relapsing after allo-SCT who obtained CMR with 2nd generation TKIs. Patients: A 21-yo man was diagnosed in March 2006 and treated with HypereCVAD+imatinib, obtaining a CHR but never achieving MMR. Eight months after diagnosis he underwent SCT. Four months later he relapsed and was treated with dasatinib 70 mg bid. CMR was obtained after 4 months. The patient selfdiscontinued dasatinib in January 2012, while still in CMR. After 6 months off-therapy he is still in CMR. A 18-yo boy was treated in December 2008 with high dose chemotherapy+imatinib, obtaining CHR with persistent molecular disease. In May 2009 he underwent transplant. He never reached MMR and relapsed in October 2009. He started treatment with dasatinib 70 mg bid, resulting in CHR full donor chimerism after 3 months. Dasatinib was replaced by nilotinib 400 mg bid for side effects. An evaluation after 10 days of nilotinib showed CMR that was kept for 3 months. The patient then relapsed and died 8 months later. A 38-yo woman was diagnosed in June 2011 and treated with steroids+imatinib 800 mg, followed by dasatinib 140 mg for intolerance. The patient underwent SCT in October 2011. Before transplant BCR/ABL was 0.3573%. At the beginning of December BM BCR/ABL increased to 0,5836% and she started dasatinib 80 mg. The level of BCR/ABL gradually decreased and the next BM evaluation showed 0,0088%. Dasatinib was reduced to 50 mg for thrombocytopenia G3 and discontinued in April 2004 for thrombocytopenia G4, when BCR/ABL was down to 0,0018% on BM and 0% on PB. The following BM evaluation in July showed CMR. Conclusions: Our patients showed a prompt response to 2-TKIs treatment that can rescue Ph+ ALL patients after SCT failure.