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Unlocking Sanctuary Sites: The Efficacy of Brexucabtagene Autoleucel in Ocular B‐ ALL Relapse

Year: 2024

Type: article

Abstract: Presentation A 52-year-old male with Philadelphia-negative (Ph-), CD20-positive B-cell acute lymphoblastic leukemia (B-ALL) achieved measurable residual disease (MRD)-negative complete remission (CR) after immunochemotherapy according to the Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA) LAL 1913 regimen (consisting of vincristine, cyclophosphamide, idarubicin, pegylatedasparaginase, cytarabine, methotrexate, 6-mercaptopurine and rituximab), and CNS-directed prophylaxis with periodical medicated lumbar punctures with intrathecal cytarabine and methotrexate [1].During standard 2-year maintenance therapy with 4-week cycles of cyclophosphamide, 6-mercaptopurine (6-MP) and methotrexate (MTX) alternating with vincristine, 6-MP and MTX, the patient complained of recurrent episodes of conjunctivitis.Conjunctivitis in a patient with B-ALL undergoing active treatment is worrisome and can be caused by either non-infectious or infectious agents.The former include leukemic infiltration and chemotherapy side effects; however, these options seem less probable.First, our patient's disease was in MRD-negative CR; second, antiblastic drugs (e.g., 6-MP and MTX) which he took during maintenance therapy, rarely cause conjunctivitis.Due to his immunocompromised state, an infectious etiology is more probable.I would ask for an ophthalmologic examination with detailed history, thorough clinical examination, and appropriate diagnostic testing.

Source: American Journal of Hematology

DOI: 10.1002/ajh.27572