Lack of association of the heparanase gene single-nucleotide polymorphism Arg307Lys with acute lymphoblastic leukaemia in patients from Northern Ireland

We usedsimilar dose of dexamethasone in our patients if it was tolerated.Three patients achieved complete remission (CR), whereaseight were refractory to TVTG. All three patients who achievedresponse had ALL (two B-ALL and one T-ALL). The median timefrom achieving a CR to transplant was 48 days (range 19–65days). Two patients (patient nos. 5 and 6), who achieved CRafter TVTG, underwent allogenic stem cell transplant and werealive and free of disease after 24 and 26 months from the start ofTVTG respectively. Patient no. 10, who achieved CR afterTVTG, underwent allogenic stem cell transplant but subse-quently died of disease relapse 13 months after treatment ofTVTG. One patient died of serious uncontrolled infection ofmultiresistant Stenothrophomonas maltophilia pneumonia,while on TVTG. Six patients had disease refractory to TVTG.Patient no. 11, who had received TVTG for T-ALL, continued tohave stable disease and was alive after 79 days of receivingTVTG without receiving any further treatment.The major toxicity was myelosuppression including grade 4neutropaenia and thrombocytopaenia (11 patients) and grade 3anaemia (nine patients). The median duration of neutropaeniawas 19 days. The most common grade 3 or 4 non-haematolo-gical toxicity was diarrhoea (n¼5). Six patients required ITUadmission of which, one died of severe uncontrolled infectionwith multiresistant S. maltophilia pneumonia. Three patientshad grade 4 septic shock, two each had grade 4 mucositis, grade4 pneumonia, grade 4 bowel toxicity and one had grade 3 livertoxicity.In summary, three (37%) out of eight patients with ALLachieved CR and underwent allogenic stem cell transplant. Allthree patients who achieved remission were young (16, 25, 36years). Since, heavily pretreated multiply relapsed or refractoryALL patients do not have better therapeutic options, TVTG maybe considered in such young adults with good performancestatus. High mortality rate (9%) and toxicity profile should betaken into account while treating adults with TVTG. Furtherstudies would be required to define the role of TVTG in otheradvanced haematological malignancies.P Hiwarkar, H-T Arkenau, J Treleaven, G Morgan, M Potterand M EthellDivision of Haematology-oncology, Royal Marsden Hospital,Sutton, Surrey, UKE-mail: drhprashant@doctors.org.ukReferences