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Blood, 1 September 2002, Vol. 100, No. 5, pp. 1590-1595
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Imatinib mesylate therapy for relapse after allogeneic stem cell
transplantation for chronic myelogenous leukemia
Hagop M. Kantarjian,
Susan O'Brien,
Jorge E. Cortes,
Sergio A. Giralt,
Mary Beth Rios,
Jianqin Shan,
Francis J. Giles,
Deborah A. Thomas,
Stefan Faderl,
Marcos De Lima,
Guillermo Garcia-Manero,
Richard Champlin,
Ralph Arlinghaus, and
Moshe Talpaz
From the Departments of Leukemia, Blood and Marrow
Transplantation, Molecular Pathology, and Bioimmunotherapy, The
University of Texas MD Anderson Cancer Center, Houston.
Twenty-eight adults with chronic myelogenous leukemia (CML) that
had relapsed after allogeneic stem cell transplantation (SCT) received
imatinib mesylate (400-1000 mg/d). Disease was in chronic phase in 5 patients, accelerated in 15, and blastic in 8 (7 medullary, 1 extramedullary); median time from transplantation to relapse was 9 months (range, 1-137 months). Thirteen patients had undergone salvage
donor lymphocyte infusion (DLI) (median time from DLI to imatinib
mesylate therapy, 4 months [range, 2-39 months]). The overall
response rate was 79% (22 of 28 patients); the complete hematologic
response (CHR) rate was 74% (17 of 23 patients), and the cytogenetic
response rate was 58% (15 of 26 patients; complete response in
9 [35%] patients). CHR rates were 100% for chronic phase, 83% for
accelerated phase, and 43% for blastic phase. The patient with
extramedullary blastic disease achieved complete response. Cytogenetic
response rates were 63% (12 of 19 patients) for chronic or accelerated
phases (complete cytogenetic response in 8) and 43% for blastic phase
(3 of 7 patients). At median follow-up of 15 months, 19 patients were
alive, 9 with no evidence of disease. The 1-year estimated survival
rate was 74%. Five patients had recurrence of grade 3 (3 patients) or
grades 1 to 2 (2 patients) graft-versus-host disease (GVHD). Severe
granulocytopenia developed in 43% of patients and thrombocytopenia in
27%; both conditions reversed with dose adjustments of imatinib
mesylate. We conclude that imatinib mesylate effectively controlled CML
that recurred after allogeneic SCT, but it was associated with side
effects including myelosuppression and recurrence of severe GVHD.
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Related Letter in Blood Online:
-
Molecular response to imatinib mesylate following relapse after allogeneic SCT for CML
- Shaun R. McCann, Kathy Gately, Eibhlin Conneally, and Mark Lawler
Blood 2003 101: 1200.
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