title: Imatinib use immediately before stem cell transplantation in children with Philadelphia chromosome-positive acute lymphoblastic leukemia: Results from Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG) Study Ph(+) ALL04.
abstract: Incorporation of imatinib into chemotherapeutic regimens has improved the prognosis of children with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+) ALL). We investigated a role of imatinib immediately before hematopoietic stem cell transplantation (HSCT). Children with Ph(+) ALL were enrolled on JPLSG Ph(+) ALL 04 Study within 1 week of initiation of treatment for ALL. Treatment regimen consisted of Induction phase, Consolidation phase, Reinduction phase, 2 weeks of imatinib monotherapy phase, and HSCT phase (Etoposide+CY+TBI conditioning). Minimal residual disease (MRD), the amount of BCR-ABL transcripts, was measured with the real-time PCR method. The study was registered in UMIN-CTR: UMIN ID C000000290. Forty-two patients were registered and 36 patients (86%) achieved complete remission (CR). Eight of 17 patients (47%) who had detectable MRD at the beginning of imatinib monotherapy phase showed disappearance or decrease in MRD after imatinib treatment. Consequently, 26 patients received HSCT in the first CR and all the patients had engraftment and no patients died because of complications of HSCT. The 4-year event-free survival rates and overall survival rates among all the 42 patients were 54.1 ± 7.8% and 78.1 ± 6.5%, respectively. Four of six patients who did achieve CR and three of six who relapsed before HSCT were salvaged with imatinib-containing chemotherapy and subsequently treated with HSCT. The survival rate was excellent in this study although all patients received HSCT. A longer use of imatinib concurrently with chemotherapy should eliminate HSCT in a subset of patients with a rapid clearance of the disease.
authors: Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan.
authors: Atsushi
authors: A
authors: Manabe
authors: Department of Pediatrics, Kansai Medical University Hirakata Hospital, Osaka, Japan.
authors: Hirohide
authors: H
authors: Kawasaki
authors: Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.
authors: Hiroyuki
authors: H
authors: Shimada
authors: Pediatrics, Graduate School of Medicine Kyoto University, Kyoto, Japan.
authors: Itaru
authors: I
authors: Kato
authors: Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors: Yuichi
authors: Y
authors: Kodama
authors: Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan.
authors: Atsushi
authors: A
authors: Sato
authors: National Research Institute for Child Health and Development, Tokyo, Japan.
authors: Kimikazu
authors: K
authors: Matsumoto
authors: Department of Pediatrics, Ibaraki Children's Hospital, Mito, Japan.
authors: Keisuke
authors: K
authors: Kato
authors: Department of Pediatrics, Tokai University, Isehara, Japan.
authors: Hiromasa
authors: H
authors: Yabe
authors: Department of Hematology/Oncology, Shizuoka Children's Hospital, Shizuoka, Japan.
authors: Kazuko
authors: K
authors: Kudo
authors: Department of Pediatrics, University of Tokyo, Tokyo, Japan.
authors: Motohiro
authors: M
authors: Kato
authors: MPH Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan.
authors: Tomohiro
authors: T
authors: Saito
authors: MPH Laboratory of Clinical, Epidemiological and Health services Research, Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Aichi, Japan.
authors: Akiko M
authors: AM
authors: Saito
authors: Deprtment of Pediatrics, Aichi Medical University, Nagakute, Japan.
authors: Masahito
authors: M
authors: Tsurusawa
authors: Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
authors: Keizo
authors: K
authors: Horibe
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D007564:Japan; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D000068877:Imatinib Mesylate
keywords: HSCT; MRD; Ph+ALL; children; imatinib
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