Epigenetic therapy overcomes treatment resistance in T cell prolymphocytic leukemia

Zainul S. Hasanali, Bikramajit Singh Saroya, August Stuart, Sara Shimko, Juanita Evans, Mithun Vinod Shah, Kamal Sharma, Violetta V. Leshchenko, Samir Parekh, Thomas P. Loughran, Elliot M. Epner

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41 Scopus citations


T cell prolymphocytic leukemia (T-PLL) is a rare, mature T cell neoplasm with distinct features and an aggressive clinical course. Early relapse and short overall survival are commonplace. Use of the monoclonal anti-CD52 antibody alemtuzumab has improved the rate of complete remission and duration of response to more than 50% and between 6 and 12 months, respectively. Despite this advance, without an allogeneic transplant, resistant relapse is inevitable. We report seven complete and one partial remission in eight patients receiving alemtuzumab and cladribine with or without a histone deacetylase inhibitor. These data show that administration of epigenetic agents can overcome alemtuzumab resistance. We also report epigenetically induced expression of the surface receptor protein CD30 in T-PLL. Subsequent treatment with the anti-CD30 antibody-drug conjugate brentuximab vedotin overcame organ-specific (skin) resistance to alemtuzumab. Our findings demonstrate activity of combination epigenetic and immunotherapy in the incurable illness T-PLL, particularly in the setting of previous alemtuzumab therapy.

Original languageEnglish
Article number293ra102
JournalScience Translational Medicine
Issue number293
StatePublished - 24 Jun 2015


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