Early T-Cell Precursor Acute Lymphoblastic Leukemia (ETP-ALL) is an aggressive and rare subtype of acute lymphoblastic leukemia (ALL) that arises from immature T-cells. ETP-ALL is characterized by its unique genetic and immunophenotypic features, which differentiate it from other types of T-cell ALL. This disease typically affects adolescents and young adults, and it often presents with a high white blood cell count, enlarged lymph nodes, and other systemic symptoms. ETP-ALL is challenging to treat due to its resistance to standard chemotherapy regimens, necessitating more intensive treatment approaches, including targeted therapies and stem cell transplantation. Recent research studies and trials have changed treatment protocols over the past several years which has led to improved prognosis regarding this diagnosis.
Shannon’s only noticeable sympton was enlarged lymph nodes in her neck. The lymph nodes first appeared on one side, then both sides. She may have also had fatigue but she worked a lot and being fatigued was her norm so it didn’t cause any concern. The lymph node enlargement got progressively worse up until diagnosis. The enlarged lymph nodes first appeared about 2 months prior to diagnosis and before they started causing her pain and discomfort. That was in late June and she was admitted to the hospital around July 1st, 2024. It took about a week and a half to get her diagnosis. Once admitted, we had several events that caused delays in procedures and lab results including: The 4th of July Holiday, a weekend, and Hurricane Beryl. Once chemotherapy and IV corticosteroids were started, her lymph nodes started shrinking and her pain was greatly reduced.
She is being treated with a chemotherapy protocol called Hyper-CVAD(Cyclophosphamide, Vincristine, Adriamycin, Dexamathasone) / Methotrextate(MTX) / Cytarabine(ARA-C) and and oral drug called venetoclax. In addition to these IV drugs, she’s also receiving intrathecal doses of Methotrexate and Cytarabine (approximately 10 doses). The IT Chemo (Intrathecal Chemo) is to prevent the disease from spreading to her neurological system. The intrathecal space is a fluid-filled area that lies within the spinal canal but outside the spinal cord. The IV chemo regimens are divied into 2 cycles, “A” and “B”. On “A” cycles she receives CVAD and on “B” Cycles she receives MTX/ ARA-C. During both A and B cycles, she also takes the oral drug venetoclax. She will do cycles A and B a total of four times (1A/1B, 2A/2B, 3A/3B, 4A/4B), then move on to prepare for bone marrow transplant which includes whole body irradiation prior to transplant. Her Bone Marrow Transplant will be performed at Houston Methodist Hospital TMC. Shannon is also on several medications to keep her from getting infections while her immune system is low, and to manage side effects. She’s on 2 antibiotics, 1 antiviral, 1 antifungal, 1 drug to prevent tumor lysis syndrome and several drugs as needed for pain and nausea.