Salvage Therapy in Early Relapse of T-Lymphoblastic Leukemia/Lymphoma Using Daratumumab/Nelarabine Combination: Two Consecutive Cases

Table 1

Overview of salvage therapy with daratumumab/nelarabine combination.

	Case 1	Case 2
Daratumumab	16 mg/kg i.v., d1 weekly for 13 weeks (till start of conditioning)	16 mg/kg i.v., d1 weekly for 8 weeks and thereafter every 2 weeks till relapse (total 17 infusions)
Nelarabine	1500 mg/m2, d1, 3, 5 every 3 weeks, 4 courses	1500 mg/m2, d1, 3, 5 every 3 weeks, 2 courses
Dexamethasone	40 mg, d1–4 every 3 weeks, 4 courses	40 mg, d1–4 every two weeks, 2 courses
PEG-asparaginase	1000 mg/m2 i.m., d1 every 3 weeks, 4 courses	not used
PEG-filgrastim	6 mg s.c., d7 every 3 weeks, 4 courses	6 mg s.c., d7 every 3 weeks, 2 courses
Effect on relapse of T-lymphoblast disease	CR : bone marrow after 3 weeks; CR : PET/CT scan after 6 weeks	Partial remission after 3 weeks; CR, neg. PCR after 6 weeks; CR, neg. PCR and FC after 9 weeks; Second relapse d196
Side effects, first 3 weeks	Bone marrow impairment, need for transfusions	Fatigue, sore muscles first few days; Thrombocytopenia
Side effects, subsequent weeks	Grade I-II sensory polyneuropathy (hands, feet); Bone marrow impairment; Uncomplicated neutropenic fever; Weakness	Grade III GVHD (liver, intestine); Bacteremia x 2; Bone marrow impairment; Grade I sensory polyneuropathy (hands)
Side effects, after conditioning	Grade III-IV neurological impairment (see text)	No re-SCT