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Chemotherapy-phased imatinib pulses improve long-term outcome of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: Northern Italy Leukemia Group protocol 09/00
- Source :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 28(22)
- Publication Year :
- 2010
-
Abstract
- Purpose Short imatinib pulses were added to chemotherapy to improve the long-term survival of adult patients with Philadelphia chromosome (Ph) –positive acute lymphoblastic leukemia (ALL), to optimize complete remission (CR) and stem-cell transplantation (SCT) rates. Patients and Methods Of 94 total patients (age range, 19 to 66 years), 35 represented the control cohort (ie, imatinib-negative [IM-negative] group), and 59 received imatinib 600 mg/d orally for 7 consecutive days (ie, imatinib-positive [IM-positive] group), starting from day 15 of chemotherapy course 1 and from 3 days before chemotherapy during courses 2 to 8. Patients in CR were eligible for allogeneic SCT or, alternatively, for high-dose therapy with autologous SCT followed by long-term maintenance with intermittent imatinib. Results CR and SCT rates were greater in the IM-positive group (CR: 92% v 80.5%; P = .08; allogeneic SCT: 63% v 39%; P = .041). At a median observation time of 5 years (range, 0.6 to 9.2 years), 22 patients in the IM-positive group versus five patients in the IM-negative group were alive in first CR (P = .037). Patients in the IM-positive group had significantly greater overall and disease-free survival probabilities (overall: 0.38 v 0.23; P = .009; disease free: 0.39 v 0.25; P = .044) and a lower incidence of relapse (P = .005). SCT-related mortality was 28% (ie, 15 of 54 patients), and postgraft survival probability was 0.46 overall. Conclusion This imatinib-based protocol improved long-term outcome of adult patients with Ph-positive ALL. With SCT, post-transplantation mortality and relapse remain the major hindrance to additional therapeutic improvement. Additional intensification of imatinib therapy should warrant a better molecular response and clinical outcome, both in patients selected for SCT and in those unable to undergo this procedure.
- Subjects :
- Adult
Male
Cancer Research
medicine.medical_specialty
medicine.drug_class
Prognosi
medicine.medical_treatment
Philadelphia chromosome
Gastroenterology
Tyrosine-kinase inhibitor
Disease-Free Survival
Drug Administration Schedule
Piperazines
MED/15 - MALATTIE DEL SANGUE
hemic and lymphatic diseases
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Medicine
Humans
Piperazine
Aged
Chemotherapy
Philadelphia Chromosome Positive
Antineoplastic Combined Chemotherapy Protocol
business.industry
Remission Induction
Imatinib
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
medicine.disease
Prognosis
Surgery
Transplantation
Leukemia
Imatinib mesylate
Pyrimidines
Oncology
Pyrimidine
Italy
Benzamides
Imatinib Mesylate
Female
business
medicine.drug
Human
Stem Cell Transplantation
Subjects
Details
- ISSN :
- 15277755
- Volume :
- 28
- Issue :
- 22
- Database :
- OpenAIRE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Accession number :
- edsair.doi.dedup.....3ab0a62c1d60117a426e13abfeb1e66b