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Response to imatinib in patients who relapse after allogeneic stem cell transplantation for chronic myeloid leukemia

Leukemia volume 17, page 1722 (2003)Cite this article

Before 1990, a patient relapsing with chronic myeloid leukemia (CML) after an allogeneic bone marrow transplant (BMT) had two options: go back to interferon (IFN) or hydroxyurea (HU), or have a second transplant. Survival in our experience for 12 CML patients, grafted in chronic/accelerated phase, from an HLA-identical sibling before 1990, alive on day 100, and relapse was 53% at 10 years (unpublished). In 1990, donor lymphocyte infusions (DLIs) were introduced, adding a third option for patients who relapsed: in our experience this was beneficial, since survival of 46 CML patients grafted beyond 1990, alive on day 100, relapsing and given DLI is now 70% at 10 years. In multicenter studies, results have been less favorable: in a recent analysis, Guglielmi et al1 studied 500 CML patients who relapsed before July 1996: survival for patients with no risk factors (less than 2 years from diagnosis, first chronic phase, cytogenetic relapse or chronic phase at relapse, time from transplant to relapse of less than 1 year and HLA-identical sibling transplant) was 42% at 10 years.

In this issue of Leukemia, Olavarria et al2 have reported a series of CML patients, who relapsed after an allograft and were treated with imatinib mesylate. Almost 50% were given imatinib as second-line therapy, after failing DLI. Nevertheless, 50% had a complete cytogenetic response and 25% a complete molecular response. There was no risk of graft-versus-host disease. Survival for patients with cytogenetic relapse of chronic phase relapse is 100%. Therefore, patients with CML relapsing after an allograft now have a fourth treatment option. It will be interesting to see how escalating dose DLI and imatinib can be optimized to produce maximum benefit with minimal toxicity. This may also open trials involving reduced intensity conditioning regimen, with very low mortality (less than 5%) and post-transplant prevention and treatment of relapse with imatinib and cells.

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References

  1. Guglielmi C, Arcese W, Dazzi F, Brand R, Bunjes D, Verdonck LF et al. Donor lymphocyte infusion for relapsed chronic myelogenous leukemia: prognostic relevance of the initial cell dose. Blood 2002; 100: 397–405.

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  2. Olavarria E, Oliver GO, Michael D, Richard EC, Guiseppe B, Jenny B et al. for the Chronic Leukaemia Working Party of the European Group of Bone and Marrow Transplantation (EBMT). Response to imatinib in patients who relapse after allogeneic stem cell transplantation for chronic myeloid leukemia. Leukemia 2003; 17: 1707–1712.

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  1. Department of Hematology, Osp San Martino, Genova, Italy

    A Bacigalupo

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Bacigalupo, A. Response to imatinib in patients who relapse after allogeneic stem cell transplantation for chronic myeloid leukemia. Leukemia 17, 1722 (2003). https://doi.org/10.1038/sj.leu.2403072

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  • DOI: https://doi.org/10.1038/sj.leu.2403072

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