The treatment of pediatric Philadelphia positive (Ph+) leukemias in the imatinib era.
BACKGROUND
As the treatment of Philadelphia positive (Ph+) leukemias in the era of imatinib continues to evolve, the role of allogeneic hematopoietic cell transplantation (allogeneic-HCT) in first remission is becoming more unclear.


METHODS
Thirty-two pediatric centers across the United States and Canada were surveyed regarding current treatment practices for Ph+ acute lymphoblastic leukemia (ALL) and chronic myelogenous leukemia (CML). The survey addressed treatment approaches for Ph+ ALL and CML in terms of imatinib therapy and use of allogeneic-HCT.


RESULTS
Twenty-three of the 32 centers returned the survey to provide a 72% response rate. Of the 27 physicians responding to the survey, 22 (81%) recommended a matched sibling donor (MSD) allogeneic-HCT, when available, in first remission for Ph+ ALL compared to 17/27 (63%) for patients with first chronic phase CML. There was universal agreement among survey responders regarding the use of imatinib upfront in Ph+ ALL and CML patients while 13 of 27 (48%) physicians reported using imatinib as maintenance therapy post-HCT for Ph+ ALL compared to 9 of 27 (33%) for CML.


CONCLUSIONS
Although a treatment consensus did not exist based on the results of this small survey, current treatment practices for pediatric Ph+ ALL and CML appear to favor allogeneic-HCT when a MSD is available. The use of post-HCT imatinib as maintenance therapy to avoid relapse for either Ph+ ALL or CML remains uncertain and awaits future prospective studies.
Burke
Michael J
MJ
Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, University of Minnesota Children's Hospital-Fairview, Minneapolis, Minnesota 55455, USA. burke283@umn.edu
Willert
Jennifer
J
Desai
Sunil
S
Kadota
Richard
R
D001549:Benzamides; D002170:Canada; D003625:Data Collection / Q000706:statistics & numerical data; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D010820:Physicians / Q000706:statistics & numerical data; D010879:Piperazines / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011743:Pyrimidines / Q000627:therapeutic use*; D035781:Siblings; D014019:Tissue Donors; D014184:Transplantation, Homologous; D014481:United States
D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate