title: Successful treatment with imatinib-combined chemotherapy for relapsed Philadelphia-positive acute lymphoblastic leukemia after allogeneic bone marrow transplantation.
abstract: The prognosis of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+)ALL) relapsing after allogeneic hematopoietic stem cell transplantation is dismal. Here we describe a patient with post-transplant relapse of Ph(+)ALL, who has remained in complete remission (CR) for 30 months after relapse. A 55-year-old woman with Ph(+)ALL received allo-HSCT from an unrelated donor during first CR. The conditioning regimen consisted of fludarabine+melphalan, and graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus and short-term methotrexate. She achieved and maintained molecular remission without developing GVHD after transplantation, but suffered a hematologic relapse on day 871. She received imatinib-combined chemotherapy, and again achieved molecular remission. Since the completion of imatinib-combined chemotherapy, she has been receiving imatinib monotherapy. Although it has been reported that chemotherapy and imatinib are effective only transiently in patients with relapsed Ph(+)ALL, our patient has remained in molecular remission for 30 months after post-transplant relapse at the time of this report. Our case suggests that by continuing imatinib after the induction of molecular remission by imatinib-combined chemotherapy, the antileukemic activity of imatinib could achieve durable remission in combination with the graft-versus-leukemia effect. However, this needs to be investigated in studies involving a large number of patients.
authors.affiliation: Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: IMAHASHI
authors.forename: Masahiro
authors.initials: M
authors.lastname: TOKUNAGA
authors.forename: Satoshi
authors.initials: S
authors.lastname: NISHIWAKI
authors.forename: Mayumi
authors.initials: M
authors.lastname: YANAGISAWA
authors.forename: Yukiyasu
authors.initials: Y
authors.lastname: OZAWA
authors.forename: Koichi
authors.initials: K
authors.lastname: MIYAMURA
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001549:Benzamides; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D020544:Graft vs Leukemia Effect; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000068877:Imatinib Mesylate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010879:Piperazines / Q000008:administration & dosage*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011743:Pyrimidines / Q000008:administration & dosage*; D012074:Remission Induction; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate