Response to imatinib in patients who relapse after allogeneic stem cell transplantation for chronic myeloid leukemia

Abstract

We studied 128 patients with chronic myeloid leukemia (CML) relapsing after allogeneic stem cell transplantation (SCT). Disease at the time of treatment with Imatinib was in chronic phase (CP) in 51 patients, accelerated phase (AP) in 31 and blastic crisis (BC) in 46. Of the 51 patients in CP, 14 were in cytogenetic and two in molecular relapses. The median interval between relapse and Imatinib therapy was 5 months (0-65). A total of 50 patients had failed treatment with donor lymphocyte infusions prior to Imatinib. The overall hematological response rate was 84% (98% for patients relapsing in CP). The complete cytogenetic response (CCR) was 58% for patients in CP, 48% for AP and 22% for patients in BC. Complete molecular responses were obtained in 25 patients (26%), of whom 21 were in CP or AP. With a median follow-up of 9 months, the estimated 2-year survival for CP, AP and BC patients was 100, 86 and 12%, respectively. Out of 79 evaluable patients, 45 (57%) achieved full donor and 11 (14%) mixed chimerism after Imatinib. We conclude that Imatinib has significant activity against CML in relapse after allogeneic SCT. Durable cytogenetic and molecular remissions are obtainable in patients in CP.

Relapse of chronic myeloid leukemia after allogeneic stem cell transplantation: outcome and prognostic factors. The Chronic Myeloid Leukemia Subcommittee of the GETH (Grupo Español de Trasplante Hemopoyético)

“…These results seem to be comparable to those obtained in CP patients and better than those reported in AP patients with DLI as first-line treatment. 10,11,13,15 Incidence of severe GvHD and marrow suppression after imatinib was low in this study; however, other authors have recently reported recurrence of GvHD and severe trombocytopenia and granulocytopenia in up to 40% of patients treated with imatinib. 14 The efficacy of imatinib must be compared with DLI, which has a response rate of 64-86%, associates severe GvHD in 50% of patients, and marrow aplasia in up to 25% of patients with hematological relapses.…”

“…In this sense, a retrospective EBMT study has shown the results of treating with imatinib a total of 128 patients relapsing in different phases of the disease (51 CP, 31 AP, and 46 BC). 13 A total of 50 patients had failed treatment with DLI prior to imatinib. The complete cytogenetic response was 58% for patients in CP, 48% for AP, and 22% for patients in BC.…”

“…Standard therapies for CML, a-interferon (a-IFN), donor lymphocyte infusion (DLI), second allogeneic SCT, and, more recently, imatinib have all been used with variable degrees of success. [7][8][9][10][11][12][13][14] In a previous retrospective study of the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT), based on 500 CML patients who relapsed after an allogeneic SCT, overall survival was 34% at 5 years. 15 A number of prognostic factors were identified and allowed the authors to differentiate between different risk groups for outcome after relapse.…”

Management of chronic myeloid leukaemia in relapse following donor lymphocyte infusion induced remission: a retrospective study of the clinical trials committee of the British Society of Blood & Marrow Transplantation (BSBMT)

“…Imatinib mesylate has been widely used to restore remission in patients relapsing after allogeneic SCT. [12][13][14] These series have reported patients with predominantly haematologicalal relapse post allogeneic SCT, some of whom also received DLI either prior to or concurrently with imatinib. Kantarjian et al 12 reported a series of 28 patients who achieved a complete haematological response rate of 74% and cytogenetic response rate of 58%, with CCR in 35%.…”

Leucemia mieloide crônica e outras doenças mieloproliferativas crônicas

“…Outros foram tratados em recidiva citogenética ou hematológica, frequentemente na presença de imunossupressão para o tratamento da DECH e/ou falência da ILD. [81][82][83][84][85] O EBMT reportou uma análise retrospectiva de 128 pacientes tratados com IM para recidiva após um TCTH. 80 A resposta hematológica global foi de 84% (98% para os pacientes em FC).…”