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Blood, 15 February 2004, Vol. 103, No. 4, pp. 1495-1498.
Prepublished online as a Blood First Edition Paper on October 23, 2003; DOI 10.1182/blood-2003-01-0154.
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NEOPLASIA
Brief report
Early prediction of response in patients with relapsed or refractory Philadelphia chromosome–positive acute lymphoblastic leukemia (Ph+ALL) treated with imatinib
Barbara Wassmann,
Heike Pfeifer,
Urban J. Scheuring,
Anja Binckebanck,
Nicola Gökbuget,
Johannes Atta,
Patrick Brück,
Harald Rieder,
Claudia Schoch,
Lothar Leimer,
Rainer Schwerdtfeger,
Gerhard Ehninger,
Thomas Lipp,
Jolanta Perz,
Matthias Stelljes,
Harald Gschaidmeier,
Dieter Hoelzer, and
Oliver G. Ottmann
From the Department of Hematology/Oncology of the University Hospitals Frankfurt, Munich, Dresden, Heidelberg, and Münster, Germany; the Department of Cytogenetics, University of Marburg, Germany; Robert Bosch Klinik Stuttgart, Germany; Deutsche Klinik für Diagnostik Wiesbaden, Germany; Hospital Munich-Schwabing, Germany; and Novartis Pharma AG, Nürnberg, Germany.
Imatinib has pronounced but brief antileukemic activity in advanced Philadelphia chromosome–positive acute lymphoblastic leukemia (Ph+ALL). We assessed the prognostic impact of pretreatment disease features and the early bone marrow (BM) response in 68 consecutive patients with Ph+ALL receiving imatinib salvage therapy. A complete hematologic or marrow response was achieved by 92% of patients with BM blasts below 5% on day 14, whereas 62.5% of patients with more than 5% BM blasts on day 14 were nonresponders. Similarly, time to progression (TTP) was superior in patients with a good day 14 response (5.2 versus 0.9 months; P < .0001). Prior complete remission of less than 6 months, white blood cell count of more than 10 x 109/L, circulating peripheral blood blasts at diagnosis, additional Philadelphia chromosomes, or at least 2 Bcr-Abl fusion signals were associated with significantly inferior remission rate and response duration. In patients without poor prognostic features, single-agent imatinib may be appropriate before transplant salvage therapy. Conversely, patients with clinically or cytogenetically defined poor-risk features are candidates for trials of upfront imatinib in combination with other agents.
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