title: Imatinib combined with myeloablative allogeneic hematopoietic stem cell transplantation for advanced phases of chronic myeloid leukemia.
abstract: To evaluat the efficacy and safety of myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) combined with imatinib for advanced chronic myeloid leukemia (CML), 15 patients with accelerated phase (n=6) or blast crisis (n=9) were enrolled in this study. All the patients were conditioned with cyclophosphamide and busulfan, and treated with cyclosporin (CsA)/methotrexate (MTX)/mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis. Eleven of these 15 patients (73.3%) achieved complete hematologic response to pre-transplant imatinib, and six (40%) achieved a cytogenetic response. No engraftment failure was observed and the early transplant-related mortality was only 6.7%. Grade 3/4 acute GVHD occurred in 13.3% of patients. Chronic GVHD was observed in 61.5%, including 23.1% suffered from extensive disease. The 5-year estimated rates of relapse, transplant-related mortality and overall survival were 21.0±10.8% 13.7±10.8% and 66.0±12.4%, respectively. Ten (66.7%) of 15 patients are alive with complete molecular remission, even after a median follow-up of 25 months after withdrawal of imatinib. In conclusion, even CML in advanced phases may have a satisfactory outcome after myeloablative allo-HSCT combined with imatinib, which may provide good remission prior to transplantation and reduce relapse risk, with low toxicity.
authors.affiliation: Bone Marrow Transplant Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Luo
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Zhao
authors.forename: Yamin
authors.initials: Y
authors.lastname: Tan
authors.forename: Jimin
authors.initials: J
authors.lastname: Shi
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Han
authors.forename: Yanlong
authors.initials: Y
authors.lastname: Zheng
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Jingsong
authors.initials: J
authors.lastname: He
authors.forename: Wanzhuo
authors.initials: W
authors.lastname: Xie
authors.forename: Xiujin
authors.initials: X
authors.lastname: Ye
authors.forename: Zhen
authors.initials: Z
authors.lastname: Cai
authors.forename: Maofang
authors.initials: M
authors.lastname: Lin
authors.forename: He
authors.initials: H
authors.lastname: Huang
mesh_terms: D000328:Adult; D001549:Benzamides; D001752:Blast Crisis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002066:Busulfan / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects; D006086:Graft vs Host Disease / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D010879:Piperazines / Q000008:administration & dosage*; D011743:Pyrimidines / Q000008:administration & dosage*; D012074:Remission Induction; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D001549:Benzamides; D019653:Myeloablative Agonists; D010879:Piperazines; D011743:Pyrimidines; D016572:Cyclosporine; D000068877:Imatinib Mesylate; D003520:Cyclophosphamide; D002066:Busulfan; D009173:Mycophenolic Acid; D008727:Methotrexate