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Imatinib interim therapy between chemotherapeutic cycles and in vivo purging prior to autologous stem cell transplantation, followed by maintenance therapy is a feasible treatment strategy in Philadelphia chromosome-positive acute lymphoblastic leukemia

Bone Marrow Transplantation volume 36, pages 917–918 (2005)Cite this article

The Philadelphia chromosome (Ph) is the most frequent cytogenetic abnormality (20–30%) in adults with acute lymphoblastic leukemia (ALL) and has an increasing incidence with age.1 The majority of patients with Ph+ ALL have a poor prognosis when treated with chemotherapy alone. Allogeneic stem cell transplantation (SCT) is still the only effective treatment approach to Ph+ ALL. However, 60–70% of Ph+ ALL patients are ineligible for allogeneic SCT due to their age, lack of an HLA-compatible sibling or unrelated donor, or lack of compatible cord blood. These patients can therefore be considered for autologous SCT (ASCT), although a high incidence of relapse is the main cause of treatment failure. Imatinib (Glivec, gleevec; Norvatis Pharma, Basel, Switzerland) is a potent inhibitor of the oncogenic bcr-abl tyrosine kinase. In phase I and II studies, imatinib induced overall response rates of 70–82%, including 25–55% complete remission (CR), in patients with Ph+ ALL or chronic myeloid leukemia in lymphoid blast crisis.2 Hence, imatinib can be used for in vivo purging before ASCT, followed by maintenance therapy after transplantation.

In September 2002, a 43-year-old female experienced intermittent syncope; she was admitted to our hospital and diagnosed with Ph+ ALL in October 2002. The leukemic immunophenotype at diagnosis was CD19, CD10, CD34, CD45, TdT, MPO and HLA DR positive, and CD13, CD33, CD14, CD2 and CD5 negative. Cytogenetic analysis showed a karyotype of 46 XX, t(9;22)(q34;q11.2), and she was positive for bcr-abl minor by RT-PCR (e1a2). She was treated with two courses of HyperCVAD followed by a third cycle with high-dose cytarabine (2 g/m2 i.v. twice daily on days 1–4) and daunorubicin (45 mg/m2 on days 1 and 2). She achieved a complete hematologic response (CHR) after one course of HyperCVAD. She received imatinib (400 mg/day) for 4 weeks between chemotherapy cycles and for 2 weeks during a third cycle of chemotherapy for in vivo purging of leukemic blasts. She subsequently received imatinib 400 mg/day to bridge the time to ASCT.

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  1. Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, College of Medicine, Pusan National University, Busan, Republic of Korea

    H-J Shin, J S Chung & G J Cho

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Shin, HJ., Chung, J. & Cho, G. Imatinib interim therapy between chemotherapeutic cycles and in vivo purging prior to autologous stem cell transplantation, followed by maintenance therapy is a feasible treatment strategy in Philadelphia chromosome-positive acute lymphoblastic leukemia. Bone Marrow Transplant 36, 917–918 (2005). https://doi.org/10.1038/sj.bmt.1705144

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