title: Imatinib and methylprednisolone alternated with chemotherapy improve the outcome of elderly patients with Philadelphia-positive acute lymphoblastic leukemia: results of the GRAALL AFR09 study.
abstract: Acute lymphoblastic leukemia (ALL) in the elderly is characterized by its ominous prognosis. On the other hand, imatinib has demonstrated remarkable, although transient, activity in relapsed and refractory Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL), which prompted us to assess the use of imatinib in previously untreated elderly patients. ALL patients aged 55 years or older were given steroids during 1 week. Ph+ve cases were then offered a chemotherapy-based induction followed by a consolidation phase with imatinib and steroids during 2 months. Patients in complete response (CR) after consolidation were given 10 maintenance blocks of alternating chemotherapy, including two additional 2-month blocks of imatinib. Thirty patients were included in this study and are compared with 21 historical controls. Out of 29 assessable patients, 21 (72%, confidence interval (CI): 53-87%) were in CR after induction chemotherapy vs 6/21 (29%, CI: 11-52%) in controls (P=0.003). Five additional CRs were obtained after salvage with imatinib and four after salvage with additional chemotherapy in the control group. Overall survival (OS) is 66% at 1 year vs 43% in the control group (P=0.005). The 1-year relapse-free survival is 58 vs 11% (P=0.0003). The use of imatinib in elderly patients with Ph+ ALL is very likely to improve outcome, including OS.
authors.affiliation: Department of Hematology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium. a.delannoy@skynet.be
authors.forename: A
authors.initials: A
authors.lastname: Delannoy
authors.forename: E
authors.initials: E
authors.lastname: Delabesse
authors.forename: V
authors.initials: V
authors.lastname: Lhéritier
authors.forename: S
authors.initials: S
authors.lastname: Castaigne
authors.forename: F
authors.initials: F
authors.lastname: Rigal-Huguet
authors.forename: E
authors.initials: E
authors.lastname: Raffoux
authors.forename: F
authors.initials: F
authors.lastname: Garban
authors.forename: O
authors.initials: O
authors.lastname: Legrand
authors.forename: S
authors.initials: S
authors.lastname: Bologna
authors.forename: V
authors.initials: V
authors.lastname: Dubruille
authors.forename: P
authors.initials: P
authors.lastname: Turlure
authors.forename: O
authors.initials: O
authors.lastname: Reman
authors.forename: M
authors.initials: M
authors.lastname: Delain
authors.forename: F
authors.initials: F
authors.lastname: Isnard
authors.forename: D
authors.initials: D
authors.lastname: Coso
authors.forename: P
authors.initials: P
authors.lastname: Raby
authors.forename: A
authors.initials: A
authors.lastname: Buzyn
authors.forename: S
authors.initials: S
authors.lastname: Caillères
authors.forename: S
authors.initials: S
authors.lastname: Darre
authors.forename: C
authors.initials: C
authors.lastname: Fohrer
authors.forename: A
authors.initials: A
authors.lastname: Sonet
authors.forename: C
authors.initials: C
authors.lastname: Bilhou-Nabera
authors.forename: M-C
authors.initials: MC
authors.lastname: Béné
authors.forename: H
authors.initials: H
authors.lastname: Dombret
authors.forename: P
authors.initials: P
authors.lastname: Berthaud
authors.forename: X
authors.initials: X
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001549:Benzamides; D018572:Disease-Free Survival; D006801:Humans; D000068877:Imatinib Mesylate; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D010677:Philadelphia Chromosome; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery*; D011743:Pyrimidines / Q000008:administration & dosage / Q000627:therapeutic use*; D033581:Stem Cell Transplantation; D016896:Treatment Outcome
chemical_list: D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D008775:Methylprednisolone