TY - JOUR
T1 - The effect of prior exposure to imatinib on transplant-related mortality
AU - Deininger, Michael
AU - Schleuning, Michael
AU - Greinix, Hilde
AU - Sayer, Herbert Gottfried
AU - Fischer, Thomas
AU - Martinez, Jesus
AU - Maziarz, Richard
AU - Olavarria, Eduardo
AU - Verdonck, Leo
AU - Schaefer, Kerstin
AU - Boqué, Conxa
AU - Faber, Edgar
AU - Nagler, Arnon
AU - Pogliani, Enrico
AU - Russell, Nigel
AU - Volin, Liisa
AU - Schanz, Urs
AU - Doelken, Gottfried
AU - Kiehl, Michael
AU - Fauser, Axel
AU - Druker, Brian
AU - Sureda, Anna
AU - Iacobelli, Simona
AU - Brand, Ronald
AU - Krahl, Rainer
AU - Lange, Thoralf
AU - Hochhaus, Andreas
AU - Gratwohl, Alois
AU - Kolb, Hans
AU - Niederwieser, Dietger
PY - 2006/4
Y1 - 2006/4
N2 - Background and Objectives. Imatinib is an effective treatment for chronic myeloid leukemia (CML) and Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). However, relapse is common in patients with advanced or high risk disease. Such patients may be eligible for allogeneic stem cell transplantation (SCT), raising the question whether imatinib therapy may compromise the outcome of subsequent SCT. Design and Methods. We retrospectively analyzed 70 patients with CML and 21 with Ph+ ALL who had received imatinib prior to SCT. Data were retrieved by directly contacting centers. Multivariate analysis was used to define factors associated with major outcomes (engraftment, graft-versus-host disease, relapse, non-relapse mortality) in addition to descriptive statistics. For the CML patients major outcomes were compared with those of historical controls drawn from the EBMT registry. Results. At SCT, 44% of CML patients were in accelerated phase or blast crisis and 40% of ALL patients had active disease compared to 84% and 95% prior to imatinib. At 24 months, estimated transplant-related mortality was 44% and estimated relapse mortality 24%. Factors associated with shorter overall and progression-free survival were advanced disease at SCT and a female donor/male recipient pairing. No unusual organ toxicities were observed. Compared to historical controls, prior imatinib treatment did not influence overall survival, progression-free survival or non-relapse mortality, while there was a trend towards higher relapse mortality and significantly less chronic graft-versus-host disease. Interpretations and Conclusions. Within the limits of a heterogeneous and relatively small cohort of patients, we found no evidence that imatinib negatively affects major outcomes after SCT, suggesting that imatinib prior to SCT is safe.
AB - Background and Objectives. Imatinib is an effective treatment for chronic myeloid leukemia (CML) and Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). However, relapse is common in patients with advanced or high risk disease. Such patients may be eligible for allogeneic stem cell transplantation (SCT), raising the question whether imatinib therapy may compromise the outcome of subsequent SCT. Design and Methods. We retrospectively analyzed 70 patients with CML and 21 with Ph+ ALL who had received imatinib prior to SCT. Data were retrieved by directly contacting centers. Multivariate analysis was used to define factors associated with major outcomes (engraftment, graft-versus-host disease, relapse, non-relapse mortality) in addition to descriptive statistics. For the CML patients major outcomes were compared with those of historical controls drawn from the EBMT registry. Results. At SCT, 44% of CML patients were in accelerated phase or blast crisis and 40% of ALL patients had active disease compared to 84% and 95% prior to imatinib. At 24 months, estimated transplant-related mortality was 44% and estimated relapse mortality 24%. Factors associated with shorter overall and progression-free survival were advanced disease at SCT and a female donor/male recipient pairing. No unusual organ toxicities were observed. Compared to historical controls, prior imatinib treatment did not influence overall survival, progression-free survival or non-relapse mortality, while there was a trend towards higher relapse mortality and significantly less chronic graft-versus-host disease. Interpretations and Conclusions. Within the limits of a heterogeneous and relatively small cohort of patients, we found no evidence that imatinib negatively affects major outcomes after SCT, suggesting that imatinib prior to SCT is safe.
KW - B-cell chronic lymphoproliferative disorders
KW - Biclonality
KW - FISH
KW - Immunophenotype
KW - Intraclonal evolution
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M3 - Article
C2 - 16585011
AN - SCOPUS:33646013280
SN - 0390-6078
VL - 91
SP - 452
EP - 459
JO - Haematologica
JF - Haematologica
IS - 4
ER -