Pre-transplant imatinib-based therapy improves the outcome of allogeneic hematopoietic stem cell transplantation for BCR-ABL-positive acute lymphoblastic leukemia.

Abstract

A high complete remission (CR) rate has been reported in newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) following imatinib-based therapy. However, the overall effect of imatinib on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is undetermined. Between 2002 and 2005, 100 newly diagnosed adult patients with Ph+ALL were registered to a phase II study of imatinib-combined chemotherapy (Japan Adult Leukemia Study Group Ph+ALL202 study) and 97 patients achieved CR. We compared clinical outcomes of 51 patients who received allo-HSCT in their first CR (imatinib cohort) with those of 122 historical control patients in the pre-imatinib era (pre-imatinib cohort). The probability of overall survival at 3 years after allo-HSCT was 65% (95% confidence interval (CI), 49-78%) for the imatinib cohort and 44% (95% CI, 35-52%) for the pre-imatinib cohort. Multivariate analysis confirmed that this difference was statistically significant (adjusted hazard ratio, 0.44, P=0.005). Favorable outcomes of the imatinib cohort were also observed for disease-free survival (P=0.007) and relapse (P=0.002), but not for non-relapse mortality (P=0.265). Imatinib-based therapy is a potentially useful strategy for newly diagnosed patients with Ph+ALL, not only providing them more chance to receive allo-HSCT, but also improving the outcome of allo-HSCT.

• Authors: S Mizuta, K Matsuo, F Yagasaki, T Yujiri, Y Hatta, Y Kimura, Y Ueda, H Kanamori, N Usui, H Akiyama, Y Miyazaki, S Ohtake, Y Atsuta, H Sakamaki, K Kawa, Y Morishima, K Ohnishi, T Naoe, R Ohno
• Journal: Leukemia (Leukemia) Vol. 25 Issue 1 Pg. 41-7 (Jan 2011) ISSN: 1476-5551 [Electronic] England
• PMID: 20944676 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Benzamides
• Piperazines
• Pyrimidines
• Imatinib Mesylate
• Fusion Proteins, bcr-abl

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Benzamides
• Cause of Death
• Disease-Free Survival
• Female
• Fusion Proteins, bcr-abl (analysis)
• Graft vs Host Disease (etiology)
• Hematopoietic Stem Cell Transplantation
• Humans
• Imatinib Mesylate
• Male
• Middle Aged
• Piperazines (administration & dosage)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (mortality, therapy)
• Pyrimidines (administration & dosage)
• Transplantation, Homologous
• Treatment Outcome