[Clinical study of imatinib for treatment of Philadelphia chromosome positive acute lymphoblastic leukemia.].
OBJECTIVE
To explore the efficacy and therapeutic outcome of imatinib combined with chemotherapy or allogeneic hematopoietic stem cell transplantation (allo-HSCT) for Philadelphia chromosome positive acute lymphoblastic leukemia (ALL).


METHODS
Thirty patients from Jan 2006 to Mar 2009 were enrolled in this study. All patients received CDOLP induction chemotherapy regimen. Sixteen patients insensitive to chemotherapy were given imatinib simultaneously. Eleven of 30 patients underwent HSCT. The other 19 cases received consolidation therapy including HD-Ara-C, HD-MTX and HD-CTX. Maintenance therapy regimens were VP combined with imatinib.


RESULTS
The white blood cell (WBC) count in 17 patients was higher than 30 x 10(9)/L. Of 30 patients, 29 were B cell phenotype and 1 T cell phenotype, 24 had additional chromosomal abnormalities. The overall complete remission (CR) rate was 96.7%. The median CR duration was 9 (2 - 20) months. The 1-year and 3-year overall survival (OS) rates were (64.7 +/- 9.8)% and (30.0 +/- 12.4)%, and the event free survival (EFS) rates were (28.8 +/- 9.5)% and (19.2 +/- 10.1)%, respectively. The bcr-abl transcripts in 13 of 30 patients were continuous negative. The OS rate in patients with negative bcr-abl transcripts was higher than that with positive bcr-abl (70.7% vs 61.3%) (P = 0.189). The EFS rate of patients with continuous negative bcr-abl transcripts was significantly higher than that of patients with continuous positive bcr-abl transcripts (P = 0.01). The median overall survival duration of higher WBC count group and normal WBC count group were 10 (4 - 18) and 29(5 - 36) months, respectively. The patients of higher WBC count had lower OS and EFS rates than that of normal WBC count (46.9% and 15.5% vs 83.5% and 50.8%, respectively) (P = 0.003 and 0.009, respectively).


CONCLUSIONS
Imatinib can significantly improve molecular CR rate and CR duration for Ph(+) ALL patients. Imatinib combined with allo-HSCT is expectable to improve the curative ratio of these patients.
The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, China.
Cai-Xia
CX
Li
De-Pei
DP
Wu
Hong
H
Liu
Yue-Jun
YJ
Liu
Xiao
X
Ma
Xiao-Jin
XJ
Wu
Xiao-Chen
XC
Chen
Dao-Ping
DP
Sun
D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000068877:Imatinib Mesylate; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics
D000068877:Imatinib Mesylate; D016044:Fusion Proteins, bcr-abl