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Blood, 1 March 2008, Vol. 111, No. 5, pp. 2581-2588. Prepublished online as a Blood First Edition Paper on January 2, 2008; DOI 10.1182/blood-2007-08-107482.
Submitted August 16, 2007
Erasmus University Medical Center, Rotterdam, Netherlands * Corresponding author; email: j.cornelissen{at}erasmusmc.nl.
The HOVON cooperative study group performed a feasibility study of escalated imatinib and intravenous cytarabine in 165 patients with early chronic phase chronic myeloid leukemia (CML). Patients received two cycles of intravenous cytarabine (200 mg/m2 or 1000 mg/m2 days 1-7) in conjunction with imatinib (200 mg, 400 mg, 600 mg or 800 mg), according to predefined, successive dose levels. All dose levels proved feasible. Seven dose limiting toxicities (DLTs) were observed in 302 cycles of chemotherapy, which were caused by streptococcal bacteremia in five cases. Intermediate-dose cytarabine (1000 mg/m2) prolonged time to neutrophil recovery and platelet recovery as compared to a standard-dose (200 mg/m2). High-dose imatinib (600 mg or 800 mg) extended the time to platelet recovery as compared to a standard-dose (400 mg). More infectious complications common toxicity criteria (CTC) grade 3-4 were observed after intermediate-dose cytarabine as compared to a standard-dose of cytarabine. Early response data after combination therapy included a complete hematologic cytogenetic response in 48% and a major molecular response in 30% of patients, which increased to 46% major molecular responses at 1 year, including 13% complete molecular responses. We conclude that combination therapy of escalating dosages of imatinib and cytarabine is feasible. This study was registered at
www.kankerbestrijding.nl as #CKTO-2001-03.
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