Details

Autor(en) / Beteiligte

• Pfeifer, H
• Wassmann, B
• Bethge, W
• Dengler, J
• Bornhäuser, M
• Stadler, M
• Beelen, D
• Vucinic, V
• Burmeister, T
• Stelljes, M
• Faul, C
• Dreger, P
• Kiani, A
• Schäfer-Eckart, K
• Schwerdtfeger, R
• Lange, E
• Kubuschok, B
• Horst, H A
• Gramatzki, M
• Brück, P
• Serve, H
• Hoelzer, D
• Gökbuget, N
• Ottmann, O G

Titel

Randomized comparison of prophylactic and minimal residual disease-triggered imatinib after allogeneic stem cell transplantation for BCR–ABL1-positive acute lymphoblastic leukemia

Ist Teil von

• Leukemia, 2013-06, Vol.27 (6), p.1254-1262

Ort / Verlag

London: Nature Publishing Group UK

Erscheinungsjahr

2013

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Minimal residual disease (MRD) after allogeneic stem cell transplantation (SCT) for Ph+ acute lymphoblastic leukemia (ALL) is predictive of relapse. Imatinib administration subsequent to SCT may prevent relapse, but the role of scheduling and its impact on outcome are not known. In a prospective, randomized multicenter trial, we compared the tolerability and efficacy of post-transplant imatinib administered either prophylactically (arm A; n =26) or following detection of MRD (arm B; n =29). Prophylactic imatinib significantly reduced the incidence of molecular recurrence after SCT compared with MRD-triggered imatinib (40% vs 69%; P =0.046). Median duration of PCR negativity was 26.5 and 6.8 months, respectively ( P =0.065). Five-year survival in both interventional groups was high (80 and 74.5%), despite premature discontinuation of imatinib in the majority of patients because of poor tolerability. Relapse probability was significantly higher in patients who became MRD positive ( P =0.017). In conclusion, post-transplant imatinib results in a low relapse rate, durable remissions and excellent long-term outcome in patients with BCR–ABL1 -positive ALL irrespective of whether it is given prophylactically or MRD-triggered. Reappearance of BCR–ABL1 transcripts early after SCT or at higher levels identifies a small subset of patients who do not benefit sufficiently from imatinib, and in whom alternative approaches should be explored.