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Extended follow-up of patients treated with imatinib mesylate (gleevec) for chronic myelogenous leukemia relapse after allogeneic transplantation: durable cytogenetic remission and conversion to complete donor chimerism without graft-versus-host disease.
Clin Cancer Res 2004; 10(15):5065-71CC

Abstract

PURPOSE

Over the last several years, donor lymphocyte infusions have become the standard approach for patients with chronic myelogenous leukemia (CML) who relapse after allogeneic stem cell transplantation (SCT). Recent reports indicate that imatinib mesylate (Gleevec) can induce remissions in these patients as well. Less is known about the extent and durability of these responses.

EXPERIMENTAL DESIGN

We studied 15 patients treated with imatinib for recurrent CML after SCT, 10 patients with stable phase CML (SP-CML), 1 with accelerated phase (AP-CML), and 4 with blast phase (BP-CML). The dose of imatinib was 600 mg (n = 10) or 400 mg (n = 5) daily. Patients were followed for hematological, cytogenetic, and molecular response. A susbset of responders was followed for changes in donor-derived hematopoietic chimerism.

RESULTS

Of the 10 patients with SP-CML, all achieved a hematological response. Within 3 months, five of these patients had achieved a complete cytogenetic response (CCR). By six months, 9 of 10 patients had achieved CCR. The BCR-ABL transcript could not be detected by reverse transcription-PCR in 7 of these 9 patients. Patients who achieved CCR showed evidence of conversion to complete donor chimerism. No patient developed graft-versus-host disease. With a median follow up of 25 months, all patients are alive and 9 of 10 patients remain in CCR. Only one of the 5 patients with AP/BP-CML achieved a complete cytogenetic response.

CONCLUSIONS

We find that imatinib is well tolerated in patients with SP-CML who relapse after SCT. Responses were rapid, durable, and associated with conversion to full donor chimerism without graft-versus-host disease. Imantinib was far less effective in patients who relapsed with AP/BP-CML. Imatinib should be evaluated as either an alternative or as an adjunct to donor lymphocyte infusions for patients with SP-CML who relapse after SCT.

Authors+Show Affiliations

Dana-Farber Cancer Institute, Department of Adult Oncology, Boston, Massachusetts 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15297408

Citation

DeAngelo, Daniel J., et al. "Extended Follow-up of Patients Treated With Imatinib Mesylate (gleevec) for Chronic Myelogenous Leukemia Relapse After Allogeneic Transplantation: Durable Cytogenetic Remission and Conversion to Complete Donor Chimerism Without Graft-versus-host Disease." Clinical Cancer Research : an Official Journal of the American Association for Cancer Research, vol. 10, no. 15, 2004, pp. 5065-71.
DeAngelo DJ, Hochberg EP, Alyea EP, et al. Extended follow-up of patients treated with imatinib mesylate (gleevec) for chronic myelogenous leukemia relapse after allogeneic transplantation: durable cytogenetic remission and conversion to complete donor chimerism without graft-versus-host disease. Clin Cancer Res. 2004;10(15):5065-71.
DeAngelo, D. J., Hochberg, E. P., Alyea, E. P., Longtine, J., Lee, S., Galinsky, I., ... Soiffer, R. J. (2004). Extended follow-up of patients treated with imatinib mesylate (gleevec) for chronic myelogenous leukemia relapse after allogeneic transplantation: durable cytogenetic remission and conversion to complete donor chimerism without graft-versus-host disease. Clinical Cancer Research : an Official Journal of the American Association for Cancer Research, 10(15), pp. 5065-71.
DeAngelo DJ, et al. Extended Follow-up of Patients Treated With Imatinib Mesylate (gleevec) for Chronic Myelogenous Leukemia Relapse After Allogeneic Transplantation: Durable Cytogenetic Remission and Conversion to Complete Donor Chimerism Without Graft-versus-host Disease. Clin Cancer Res. 2004 Aug 1;10(15):5065-71. PubMed PMID: 15297408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extended follow-up of patients treated with imatinib mesylate (gleevec) for chronic myelogenous leukemia relapse after allogeneic transplantation: durable cytogenetic remission and conversion to complete donor chimerism without graft-versus-host disease. AU - DeAngelo,Daniel J, AU - Hochberg,Ephraim P, AU - Alyea,Edwin P, AU - Longtine,Janina, AU - Lee,Stephanie, AU - Galinsky,Ilene, AU - Parekkedon,Ben, AU - Ritz,Jerome, AU - Antin,Joseph H, AU - Stone,Richard M, AU - Soiffer,Robert J, PY - 2004/8/7/pubmed PY - 2005/3/8/medline PY - 2004/8/7/entrez SP - 5065 EP - 71 JF - Clinical cancer research : an official journal of the American Association for Cancer Research JO - Clin. Cancer Res. VL - 10 IS - 15 N2 - PURPOSE: Over the last several years, donor lymphocyte infusions have become the standard approach for patients with chronic myelogenous leukemia (CML) who relapse after allogeneic stem cell transplantation (SCT). Recent reports indicate that imatinib mesylate (Gleevec) can induce remissions in these patients as well. Less is known about the extent and durability of these responses. EXPERIMENTAL DESIGN: We studied 15 patients treated with imatinib for recurrent CML after SCT, 10 patients with stable phase CML (SP-CML), 1 with accelerated phase (AP-CML), and 4 with blast phase (BP-CML). The dose of imatinib was 600 mg (n = 10) or 400 mg (n = 5) daily. Patients were followed for hematological, cytogenetic, and molecular response. A susbset of responders was followed for changes in donor-derived hematopoietic chimerism. RESULTS: Of the 10 patients with SP-CML, all achieved a hematological response. Within 3 months, five of these patients had achieved a complete cytogenetic response (CCR). By six months, 9 of 10 patients had achieved CCR. The BCR-ABL transcript could not be detected by reverse transcription-PCR in 7 of these 9 patients. Patients who achieved CCR showed evidence of conversion to complete donor chimerism. No patient developed graft-versus-host disease. With a median follow up of 25 months, all patients are alive and 9 of 10 patients remain in CCR. Only one of the 5 patients with AP/BP-CML achieved a complete cytogenetic response. CONCLUSIONS: We find that imatinib is well tolerated in patients with SP-CML who relapse after SCT. Responses were rapid, durable, and associated with conversion to full donor chimerism without graft-versus-host disease. Imantinib was far less effective in patients who relapsed with AP/BP-CML. Imatinib should be evaluated as either an alternative or as an adjunct to donor lymphocyte infusions for patients with SP-CML who relapse after SCT. SN - 1078-0432 UR - https://www.unboundmedicine.com/medline/citation/15297408/Extended_follow_up_of_patients_treated_with_imatinib_mesylate__gleevec__for_chronic_myelogenous_leukemia_relapse_after_allogeneic_transplantation:_durable_cytogenetic_remission_and_conversion_to_complete_donor_chimerism_without_graft_versus_host_disease_ L2 - http://clincancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=15297408 DB - PRIME DP - Unbound Medicine ER -