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Acute Leukemias

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

Leukemia volume 25, pages 41–47 (2011)Cite this article

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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.

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Acknowledgements

We thank Dr Masamitsu Yanada and all of the physicians and staff members of the collaborating institutes of the JALSG and JSHCT. This work was supported by a Research Grant for Cancer from the Japanese Ministry of Health, Labor and Welfare.

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Authors and Affiliations

  1. Department of Hematology, Fujita Health University Hospital, Toyoake, Japan

    S Mizuta

  2. Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan

    K Matsuo

  3. Department of Hematology, Saitama Medical University International Medical Center, Saitama, Japan

    F Yagasaki

  4. Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Japan

    T Yujiri

  5. Department of Hematology, Nihon University School of Medicine, Tokyo, Japan

    Y Hatta

  6. Division of Hematology, First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan

    Y Kimura

  7. Department of Hematology/Oncology, Kurashiki Central Hospital, Kurashiki, Japan

    Y Ueda

  8. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    H Kanamori

  9. Department of Clinical Oncology and Hematology, Jikei University Daisan Hospital, Tokyo, Japan

    N Usui

  10. Department of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    H Akiyama & H Sakamaki

  11. Department of Hematology, Nagasaki University School of Medicine, Nagasaki, Japan

    Y Miyazaki

  12. Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan

    S Ohtake

  13. Department of Hematopoietic Stem Cell Transplantation Data Management/Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta

  14. Division of Hematology and Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan

    K Kawa

  15. Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan

    Y Morishima

  16. Oncology Center, Hamamatsu University School of Medicine, Hamamatsu, Japan

    K Ohnishi

  17. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    T Naoe

  18. President Emeritus, Aichi Cancer Center, Nagoya, Japan

    R Ohno

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  1. S Mizuta
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Correspondence to S Mizuta.

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Competing interests

Dr Naoe has received research funding and honoraria from Novartis Japan. Dr Ohnishi has received research funding from Novartis Japan. Dr Miyazaki has received honoraria from Novartis Japan. The remaining authors declare no conflict of interest.

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Mizuta, S., Matsuo, K., Yagasaki, F. et al. Pre-transplant imatinib-based therapy improves the outcome of allogeneic hematopoietic stem cell transplantation for BCR–ABL-positive acute lymphoblastic leukemia. Leukemia 25, 41–47 (2011). https://doi.org/10.1038/leu.2010.228

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