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KMID : 0387820100170020163
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Clinical Pediatric Hematology-Oncology
2010 Volume.17 No. 2 p.163 ~ p.173
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Allogeneic Hematopoietic Stem Cell Transplantation Following Imatinib Plus Idarubicin and High-dose Cytarabine in Children with Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia
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Ahn Seon-A
Kim Myoung-Hyun
Lee Jae-Wook
Lee Dae-Hyoung
Jang Pil-Sang
Chung Nack-Gyun
Cho Bin
Jeong Chang-Mo
Kim Hack-Ki
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Abstract
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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.
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KEYWORD
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Hematopoietic stem cell transplantation, Philadelphia chromosome, Acutelymphoblastic leukemia, Minimal residual disease, BCR-ABL
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