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Improved early event-free survival with imatinib in philadelphia chromosome-positive acute lymphoblastic leukemia: a childrens oncology group study
Journal of Clinical Oncology, 10/09/09

Schultz KR et al. – Imatinib plus intensive chemotherapy improved 3-year EFS in children and adolescents with Ph+ ALL, with no appreciable increase in toxicity. BMT plus imatinib offered no advantage over BMT alone. Additional follow-up is required to determine the impact of this treatment on long-term EFS and determine whether chemotherapy plus imatinib can replace BMT.

Methods

Evaluated whether imatinib (340 mg/m2/d) with an intensive chemotherapy regimen improved outcome in children ages 1 to 21 years with Ph+ ALL (N = 92) and compared toxicities to Ph- ALL patients (N = 65) given the same chemotherapy without imatinib
Exposure to imatinib increased progressively in 5 patient cohorts that received imatinib from 42 to 280 continuous days before maintenance therapy
Patients with HLA –identical sibling donors underwent blood and marrow transplantation (BMT) with imatinib given for 6 months following BMT

Results

Continuous imatinib exposure improved outcome in cohort 5 patients with a 3-year event-free survival (EFS) of 80% ± 11% , more than twice historical controls
3-year EFS was similar for patients in cohort 5 treated with chemotherapy plus imatinib or sibling donor BMT
No significant toxicities associated with adding imatinib to intensive chemotherapy
Higher imatinib dosing in cohort 5 appears to improve survival by having impact on outcome of children with higher burden of minimal residual disease after induction

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