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Leukemia. 2014 Jul;28(7):1467-71. doi: 10.1038/leu.2014.30. Epub 2014 Jan 20.

Long-term follow-up of imatinib in pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia: Children's Oncology Group study AALL0031.

Author information

1
Department of Pediatrics, Division of Hematology/Oncology/BMT British Columbia's Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
2
University of Alabama at Birmingham, Birmingham AL, USA.
3
Department of Pathology, The Ohio State University, Columbus, OH, USA.
4
Cook Children's Medical Center, Hematology/Oncology Fort Worth, TX, USA.
5
Phyllis and David Komansky Center for Children's Health/Weill Cornell Medical Center, New York, NY, USA.
6
Department of Pediatrics and University of Florida Shands Cancer Center, University of Florida College of Medicine, Gainesville, FL, USA.
7
Department of Preventative Medicine, University of Southern California, Los Angeles, CA, USA.
8
Children's Oncology Group Statistics & Data Center, and the University of Florida, Department of Biostatistics, Gainesville, FL, USA.
9
Ped. Hematology/Oncology/BMT, Children's Hospital Colorado and the Department of Pediatrics University of Colorado School of Medicine, Aurora, CO, USA.
10
Stem Cell Transplantation, Children's Hospital Medical Center Cincinnati, Cincinnati, OH, USA.
11
Hematology/Oncology Children's Hospital Los Angeles, Los Angeles, CA, USA.
12
Thomas Jefferson University, Philadelphia, PA, USA.
13
Department of Radiation Oncology, Nova Scotia Cancer Centre and Dalhousie University, Halifax NS, USA.
14
Midwest Children's Cancer Center, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI, USA.
15
Pediatric Hem/Onc, UT Southwestern Medical Center, Dallas, TX, USA.
16
Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA.
17
Department of Pediatrics, NYU Medical Center, New York, NY, USA.

Abstract

We previously reported preliminary findings that post induction imatinib mesylate (340 mg/m(2)/day), in combination with intensive chemotherapy, resulted in outcomes similar to blood and marrow transplant (BMT) for pediatric patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). We now report 5-year outcomes of imatinib plus intensive chemotherapy in 91 children (1-21 years) with and without allogeneic BMT (N=91). We explore the impacts of additional chromosomal abnormalities and minimal residual disease (MRD) by flow cytometry on outcomes. The 5-year disease-free survival was similar for Cohort 5 patients, treated with chemotherapy plus imatinib (70%±12%, n=28), sibling donor BMT patients (65%±11%, n=21) and unrelated donor BMT patients (59±15%; P=0.60, n=13). Patients with additional cytogenetic abnormalities had worse outcomes (P=0.05). End induction (pre-imatinib) MRD was not prognostic for Cohort 5 or allogeneic BMT patients, although limited by small numbers. The re-induction rate following relapse was similar to other higher-risk ALL groups. Longer-term follow-up confirms our initial observation of substantially good outcomes for children and adolescents with Ph+ ALL treated with imatinib plus intensive chemotherapy with no advantage for allogeneic BMT.

PMID:
24441288
PMCID:
PMC4282929
DOI:
10.1038/leu.2014.30
[Indexed for MEDLINE]
Free PMC Article

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