Clin Pediatr Hematol Oncol.  2010 Oct;17(2):163-173.

Allogeneic Hematopoietic Stem Cell Transplantation Following Imatinib Plus Idarubicin and High-dose Cytarabine in Children with Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia

• An SA
• Kim MH
• Lee JW
• Lee DH
• Jang PS
• Chung NG
• Cho B
• Jeong DC
• Kim HK

Abstract

PURPOSE
To investigate the feasibility of imatinib-combined chemotherapy prior to allogeneic hematopoietic stem cell transplantation (HSCT) in childhood Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL), we treated five children with Ph+ ALL in remission with imatinib plus idarubicin and high-dose cytarabine followed by allogeneic HSCT.
METHODS
Five children in remission received imatinib 340 mg/m2 daily with consolidation chemotherapy consisting of idarubicin (10 mg/m2 once daily) and cytarabine (3 g/m2 twice daily) for two consecutive days. After 2 to 5 cycles of consolidation chemotherapy, 4 patients underwent allogeneic peripheral blood stem cell transplantation and one underwent unrelated double unit cord blood transplantation.
RESULTS
Four patients continued imatinib-combined chemotherapy without significant toxicity until HSCT. After allogeneic HSCT, 4 patients engrafted and had complete donor chimerism. Primary graft failure occurred in one patient who had received double unit cord blood transplantation. Of the 4 evaluable patients, grade II acute GVHD occurred in two patients and chronic extensive GVHD occurred in 3 patients. Four patients survived with a median follow-up of 55 months. In 3 patients, BCR-ABL transcript level became negative after the first cycle of imatinib-combined chemotherapy and remained negative after HSCT. In one patient, the BCR-ABL was positive even after 3 cycles of imatinib-combined chemotherapy and became negative at 2 months post-HSCT.
CONCLUSION
For children with Ph+ ALL, imatinib in combination with idarubicin and high-dose cytarabine as consolidation therapy prior to HSCT appears to be effective in terms of MRD reduction and may improve the overall survival of these patients.

Keyword

Hematopoietic stem cell transplantation; Philadelphia chromosome; Acute lymphoblastic leukemia; Minimal residual disease; BCR-ABL

MeSH Terms

Benzamides
Child
Chimerism
Consolidation Chemotherapy
Cytarabine
Fetal Blood
Follow-Up Studies
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Idarubicin
Neoplasm, Residual
Peripheral Blood Stem Cell Transplantation
Philadelphia
Philadelphia Chromosome
Piperazines
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pyrimidines
Tissue Donors
Transplants
Imatinib Mesylate
Benzamides
Cytarabine
Idarubicin
Piperazines
Pyrimidines