Complete Response (CR) in a Previously-progressing Chronic Lymphocytic Leukemia (CLL) Patient Treated With Methionine Restriction in Combination With First-line Chemotherapy

Sei Morinaga; Qinghong Han; Kohei Mizuta; Byung Mo Kang; Norio Yamamoto; Katsuhiro Hayashi; Hiroaki Kimura; Shinji Miwa; Kentaro Igarashi; Takashi Higuchi; Hiroyuki Tsuchiya; Satoru Demura; Robert M Hoffman

doi:10.21873/cdp.10407

Complete Response (CR) in a Previously-progressing Chronic Lymphocytic Leukemia (CLL) Patient Treated With Methionine Restriction in Combination With First-line Chemotherapy

Cancer Diagn Progn. 2025 Jan 3;5(1):21-26. doi: 10.21873/cdp.10407. eCollection 2025 Jan-Feb.

Authors

Sei Morinaga^{1

2

3}, Qinghong Han¹, Kohei Mizuta^{1

2}, Byung Mo Kang^{1

2}, Norio Yamamoto³, Katsuhiro Hayashi³, Hiroaki Kimura³, Shinji Miwa³, Kentaro Igarashi³, Takashi Higuchi³, Hiroyuki Tsuchiya³, Satoru Demura³, Robert M Hoffman^{1

2}

Affiliations

¹ AntiCancer Inc., San Diego, CA, U.S.A.
² Department of Surgery, University of California, San Diego, CA, U.S.A.
³ Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

Abstract

Background/aim: Chronic lymphocytic leukemia (CLL) is currently incurable. CLL is characterized by disordered DNA methylation. The aim of the present study was to target methylation with methionine restriction in a patient with progressive CLL.

Case report: Methionine restriction for the patient was achieved with a low-methionine vegan diet and oral recombinant methioninase (o-rMETase). The patient also received rituximab, once per week for four weeks, and acalabrutinib 100 mg, twice daily (bid) continuously. The patient's white blood cell count decreased by 95% from peak levels and extensive lymphadenopathy disappeared during combination treatment with o-rMETase, rituximab, and acalabrutinib.

Conclusion: The combination of methionine restriction and first-line chemotherapy resulted in an apparent complete response (CR) in a CLL patient, a rare event. The duration of the CR will be monitored, and additional CLL patients will be treated similarly in the future.

Keywords: CLL; Chronic lymphocytic leukemia; acalabrutinib; combination therapy; complete response; first-line chemotherapy; methioninase; methionine restriction; rituximab.