Venetoclax combination with Cladribine, idarubicin, Cytarabine for relapsed T-Cell acute lymphoblastic leukemia/lymphoblastic lymphoma treatment: A case report and literature review

Abstract

Acute lymphoblastic leukemia (ALL) represents only 20 % of adult acute leukemias, while Lymphoblastic lymphoma is even rarer, accounting for 2 % of adult non-Hodgkin lymphomas. T-acute lymphoblastic leukemia (T-ALL) and T-lymphoblastic lymphoma (T-LBL) are neoplasms characterized by the presence of immature T-cell precursors or lymphoblasts. Relapsed T-ALL or LBL is associated with a very poor prognosis, necessitating the exploration of novel therapeutic approaches. This case report describes the use of Venetoclax in combination with Cladribine, Idarubicin, and Cytarabine (CLIA) as salvage therapy for relapsed T-ALL/T-LBL. The treatment regimen resulted in remission and negative minimal residual disease. However, it was accompanied by delayed count recovery, febrile neutropenia, and Central Line-Associated Bloodstream Infection. The management of central nervous system involvement was challenging due to low platelet counts requiring transfusion support. The findings highlight the need for further investigation into the efficacy and optimal therapeutic regimen for relapsed T-ALL/T-LBL. Additionally, the case emphasizes the importance of early salvage therapy and potentially consolidative hematopoietic stem cell transplantation for improved survival outcomes in relapsed T-ALL/T-LBL patients.