Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate
Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate
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DOI：
10.1182/blood-2003-08-2958
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发表时间：
2004-06-15
期刊：
影响因子：
20.3
通讯作者：
Kantarjian, H
中科院分区：
文献类型：
--
作者：
Thomas, DA;Faderl, S;Kantarjian, H
甲磺酸伊马替尼是一种Bcr-Abl酪氨酸激酶抑制剂，在难治性/复发性费城染色体（Ph）阳性急性淋巴细胞白血病（ALL）中具有中等活性。探讨了在新诊断的Ph阳性ALL患者中同时使用化疗和甲磺酸伊马替尼的情况。有20例患者接受hyper-CVAD（环磷酰胺、长春新碱、阿霉素和地塞米松）和甲磺酸伊马替尼，随后接受基于甲磺酸伊马替尼的巩固/维持治疗。在这些患者中，11例为新发疾病，4例为诱导后原发性失败（未使用甲磺酸伊马替尼），5例为诱导后完全缓解（CR）（未使用甲磺酸伊马替尼）。所有15例接受活动性疾病治疗的患者均达到CR。在首次CR的中位3.5个月内，10例患者接受了异基因干细胞移植（SCT）。1例患者在匹配相关SCT后复发。其余9例患者在SCT后中位随访12个月（范围，1 +至17 +个月）时仍存活于CR中。在10例不适合（无供体或年龄较大）或拒绝异基因SCT的患者中，1例患者在1年后复发。有5例患者在连续CR中存活了中位20个月（范围，4+至24+个月），2例老年患者在共病15和16个月时死于CR。两组（SCT或无SCT）均实现了分子CR。hyper-CVAD和甲磺酸伊马替尼的结局似乎优于既往方案;需要对当前队列进行持续的累积和更长时间的随访。(C)2004年，美国血液学会。
Imatinib mesylate, an inhibitor of the Bcr-Abl tyrosine kinase, has modest activity in refractory/relapsed Philadelphia chromosome (Ph)-positive acute lymphocytic leukemia (ALL). Use of concurrent chemotherapy and imatinib mesylate in newly diagnosed Ph-positive ALL was explored. There were 20 patients who received hyper-CVAD (cyclophosphamide, vincristine, Adriamycin, and dexamethasone) and imatinib mesylate followed by imatinib mesylate-based consolidation/maintenance therapy. Of these patients, 11 had de novo disease, 4 were primary failures after induction (without imatinib mesylate), and 5 were in complete remission (CR) after induction (without imatinib mesylate). All 15 patients treated for active disease achieved CR. Within a median of 3.5 months in first CR, 10 patients underwent allogeneic stem cell transplantation (SCT). One patient relapsed after matched related SCT. The other 9 patients remained alive in CR with median follow-up of 12 months after SCT (range, 1 + to 17 + months). Among 10 patients ineligible for (no donor or older age) or refusing allogeneic SCT, 1 patient relapsed after one year. There were 5 patients who remained alive in continuous CR for a median of 20 months (range, 4+ to 24+ months), with 2 older patients dying in CR at 15 and 16 months of comorbid conditions. Molecular CRs were achieved in both groups (SCT or no SCT). Outcome with hyper-CVAD and Imatinib mesylate appears better than with prior regimens; continued accrual and longer follow-up of the current cohort is needed. (C) 2004 by The American Society of Hematology.