Imatinib mesylate (STI-571) given concurrently with nonmyeloablative stem cell transplantation did not compromise engraftment and resulted in cytogenetic remission in a patient with chronic myeloid leukemia in blast crisis

Abstract

Summary:The main obstacles to successful hematopoietic stem cell transplantation for patients with chronic myeloid leukemia (CML) in blast crisis (BC) are increased posttransplant relapse and high treatment-related mortality. We report a patient with CML in BC who was treated initially with imatinib mesylate and was then concurrently treated with a nonmyeloablative stem cell transplant. Successful engraftment of donor cells followed by complete cytogenetic remission was achieved in the absence of severe therapy-related toxicities. This case demonstrates that imatinib mesylate given through nonmyeloablative transplant is a minimally toxic therapeutic approach, which does not compromise engraftment and may result in a favorable outcome in patients with CML in BC.

Allogeneic haematopoietic cell transplantation for chronic myelogenous leukaemia in the era of imatinib: a retrospective multicentre study

“…Previous reports had shown the results of allogeneic transplantation to be not negatively influenced by prior IM. Three case reports describe the successful treatment of advanced phase CML with IM before and after reduced-intensity conditioning and allogeneic HCT (19)(20)(21). Two larger studies summarize patients who had received IM for treatment of relapsed Ph+ acute lymphoblastic leukaemia or advanced CML and then received either allogeneic HCT or donor lymphocyte infusions (22,23).…”

“…Neutrophil counts of ‡500/lL were reached after a median of 15 d (range [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Platelet counts of ‡50 000/lL for 7 d were reached after a median of 18 d (range 0-83).…”

Imatinib therapy prior to myeloablative allogeneic stem cell transplantation

“…31,32 Preliminary data from a patient treated with a nonmyeloablative stem cell transplant and receiving imatinib concomitantly is also consistent with this notion. 33 Liver toxicity is a common and potentially fatal complication after myeloablative conditioning therapy. Previous studies showed that transplants recipients with pre-existing liver injury had an increased risk of liver complications and death.…”

Unrelated cord blood transplantation in CML: Japan Cord Blood Bank Network analysis

“…Both BMT and PBSC transplantation have provided reasonable results in the patients, even in those who were treated with IFN or imatinib before transplantation. 20,21 Furthermore, minimal residual clones of Ph1 were eradicated by post-HSCT donor lymphocyte infusion. 22,23 Use of UCBT in patients with CML was first reported by Rubinstein et al 3 in the context of haematopoietic malignancies.…”