Long-term follow-up of imatinib in pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia: Children's Oncology Group study AALL0031.
We previously reported preliminary findings that post induction imatinib mesylate (340 mg/m(2)/day), in combination with intensive chemotherapy, resulted in outcomes similar to blood and marrow transplant (BMT) for pediatric patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). We now report 5-year outcomes of imatinib plus intensive chemotherapy in 91 children (1-21 years) with and without allogeneic BMT (N=91). We explore the impacts of additional chromosomal abnormalities and minimal residual disease (MRD) by flow cytometry on outcomes. The 5-year disease-free survival was similar for Cohort 5 patients, treated with chemotherapy plus imatinib (70%±12%, n=28), sibling donor BMT patients (65%±11%, n=21) and unrelated donor BMT patients (59±15%; P=0.60, n=13). Patients with additional cytogenetic abnormalities had worse outcomes (P=0.05). End induction (pre-imatinib) MRD was not prognostic for Cohort 5 or allogeneic BMT patients, although limited by small numbers. The re-induction rate following relapse was similar to other higher-risk ALL groups. Longer-term follow-up confirms our initial observation of substantially good outcomes for children and adolescents with Ph+ ALL treated with imatinib plus intensive chemotherapy with no advantage for allogeneic BMT.
Department of Pediatrics, Division of Hematology/Oncology/BMT British Columbia's Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
K R
0000000200016438
KR
Schultz
University of Alabama at Birmingham, Birmingham AL, USA.
A
A
Carroll
Department of Pathology, The Ohio State University, Columbus, OH, USA.
N A
NA
Heerema
Cook Children's Medical Center, Hematology/Oncology Fort Worth, TX, USA.
W P
WP
Bowman
Phyllis and David Komansky Center for Children's Health/Weill Cornell Medical Center, New York, NY, USA.
A
A
Aledo
Department of Pediatrics and University of Florida Shands Cancer Center, University of Florida College of Medicine, Gainesville, FL, USA.
W B
WB
Slayton
Department of Preventative Medicine, University of Southern California, Los Angeles, CA, USA.
H
H
Sather
Children's Oncology Group Statistics & Data Center, and the University of Florida, Department of Biostatistics, Gainesville, FL, USA.
M
M
Devidas
Ped. Hematology/Oncology/BMT, Children's Hospital Colorado and the Department of Pediatrics University of Colorado School of Medicine, Aurora, CO, USA.
H W
HW
Zheng
Stem Cell Transplantation, Children's Hospital Medical Center Cincinnati, Cincinnati, OH, USA.
S M
SM
Davies
Hematology/Oncology Children's Hospital Los Angeles, Los Angeles, CA, USA.
P S
PS
Gaynon
Thomas Jefferson University, Philadelphia, PA, USA.
M
M
Trigg
Department of Radiation Oncology, Nova Scotia Cancer Centre and Dalhousie University, Halifax NS, USA.
R
R
Rutledge
Midwest Children's Cancer Center, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI, USA.
D
D
Jorstad
Pediatric Hem/Onc, UT Southwestern Medical Center, Dallas, TX, USA.
N
N
Winick
Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA.
M J
MJ
Borowitz
Ped. Hematology/Oncology/BMT, Children's Hospital Colorado and the Department of Pediatrics University of Colorado School of Medicine, Aurora, CO, USA.
S P
SP
Hunger
Department of Pediatrics, NYU Medical Center, New York, NY, USA.
W L
WL
Carroll
Midwest Children's Cancer Center, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI, USA.
B
B
Camitta
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001549:Benzamides / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002869:Chromosome Aberrations; D005500:Follow-Up Studies; D006801:Humans; D000068877:Imatinib Mesylate; D007223:Infant; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011743:Pyrimidines / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate