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KMID : 0366220150500030147
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Korean Journal of Hematology
2015 Volume.50 No. 3 p.147 ~ p.153
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Favorable outcome of allogeneic hematopoietic stem cell transplantation followed by post-transplant treatment with imatinib in children with Philadelphia chromosome-positive acute lymphoblastic leukemia
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Byun Ye-Jee
Suh Jin-Kyung
Lee Seong-Wook
Lee Da-Rae
Kim Hyun-Jin
Choi Eun-Seok
Koh Kyung-Nam
Im Ho-Joon
Seo Jong-JIn
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Abstract
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Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is the preferred curative ther-apy for children with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leu-kemia (ALL). We evaluated the treatment outcomes of children with Ph+ ALL who under-went allogeneic HSCT.
Methods: Fifteen children diagnosed with Ph+ ALL in Asan Medical Center Children’s Hospital be-tween 1998 and 2012 were retrospectively analyzed.
Results: Of 521 children diagnosed with ALL during the study period, 15 had a Philadelphia chromosome. Among these 15 patients, 13 attained complete remission (CR) following induction chemotherapy, and two died of intracerebral hemorrhage during leukapheresis and induction chemotherapy, respectively. Of the 13 patients who attained CR, 12 re-ceived allogeneic HSCT, mainly from unrelated donors. Of the 12 patients who received HSCT, one died of a transplant-related cause, one died of relapse after HSCT, and 10 remain in continuous CR. Of the 10 patients who remained in CR longer than six months after HSCT, seven received post-HSCT imatinib. For all 15 patients, the 5-year overall survival, event-free survival, and cumulative incidence of relapse were 60.0%, 48.6%, and 38.8%, respectively, with a median follow-up of 70 months. For the HSCT group, the 5-year overall survival, event-free survival, and cumulative incidence of relapse were 80.2%, 72.9%, and 29.3%, respectively, with a median follow-up of 100 months.
Conclusion: Allogeneic HSCT cures a significant proportion of Ph+ ALL patients. Because the use of imatinib appears to be a promising approach, strategies that include tyrosine kinase in-hibitors before and after HSCT require further evaluation.
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KEYWORD
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Philadelphia chromosome-positive acute lymphoblastic leukemia, Children, Allogeneic hematopoietic stem cell transplantation, Imatinib, Outcome
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