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Therapy

Imatinib and methylprednisolone alternated with chemotherapy improve the outcome of elderly patients with Philadelphia-positive acute lymphoblastic leukemia: results of the GRAALL AFR09 study

Leukemia volume 20, pages 1526–1532 (2006)Cite this article

Abstract

Acute lymphoblastic leukemia (ALL) in the elderly is characterized by its ominous prognosis. On the other hand, imatinib has demonstrated remarkable, although transient, activity in relapsed and refractory Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL), which prompted us to assess the use of imatinib in previously untreated elderly patients. ALL patients aged 55 years or older were given steroids during 1 week. Ph+ve cases were then offered a chemotherapy-based induction followed by a consolidation phase with imatinib and steroids during 2 months. Patients in complete response (CR) after consolidation were given 10 maintenance blocks of alternating chemotherapy, including two additional 2-month blocks of imatinib. Thirty patients were included in this study and are compared with 21 historical controls. Out of 29 assessable patients, 21 (72%, confidence interval (CI): 53–87%) were in CR after induction chemotherapy vs 6/21 (29%, CI: 11–52%) in controls (P=0.003). Five additional CRs were obtained after salvage with imatinib and four after salvage with additional chemotherapy in the control group. Overall survival (OS) is 66% at 1 year vs 43% in the control group (P=0.005). The 1-year relapse-free survival is 58 vs 11% (P=0.0003). The use of imatinib in elderly patients with Ph+ ALL is very likely to improve outcome, including OS.

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Acknowledgements

Novartis France and Belgium generously provided imatinib for this study. The Hospices Civils de Lyon endorsed the administrative burden of the legal promotion of this study.

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Authors and Affiliations

  1. Department of Hematology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium

    A Delannoy

  2. Department of Hematology, CHU Paris-Necker, Paris, France

    E Delabesse & A Buzyn

  3. Department of Hematology, Hôpital E Herriot, Lyon, France

    V Lhéritier & X Thomas

  4. Department of Hematology, Hôpital A Mignot, Versailles, France

    S Castaigne

  5. Department of Hematology, Hôpital Purpan, Toulouse, France

    F Rigal-Huguet

  6. Department of Hematology, Hôpital Saint-Louis, Paris, France

    E Raffoux & H Dombret

  7. Department of Hematology, Hôpital Michallon, Grenoble, France

    F Garban

  8. Department of Hematology, Hôtel-Dieu, Paris, France

    O Legrand

  9. Department of Hematology, CHU Nancy Brabois, Nancy, France

    S Bologna & M-C Béné

  10. Department of Hematology, Hôtel-Dieu, Nantes, France

    V Dubruille

  11. Department of Hematology, Hôpital Dupuytren, Limoges, France

    P Turlure

  12. Department of Hematology, CHU de Caen, Caen, France

    O Reman

  13. Department of Hematology, Hôpital Bretonneau, Tours, France

    M Delain

  14. Department of Hematology, Hôpital Saint-Antoine, Paris, France

    F Isnard

  15. Department of Hematology, Institut Paoli Calmettes, Marseille, France

    D Coso

  16. Department of Hematology, Hôpital L Pasteur, Colmar, France

    P Raby

  17. Department of Hematology, CH d'Aix, Aix-en-Provence, France

    S Caillères

  18. Department of Hematology, Hôpital C Huriez, Lille, France

    S Darre

  19. Department of Hematology, Hôpital de Hautepierre, Strasbourg, France

    C Fohrer

  20. Department of Hematology, Cliniques Universitaires de Godinne, Yvoir, Belgium

    A Sonet

  21. Department of Hematology, CHU du Haut-Levêque, Bordeaux, France

    C Bilhou-Nabera

  22. Department of Hematology, Novartis Pharma, Rueil Malmaison, France

    P Berthaud

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  1. A Delannoy
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  2. E Delabesse
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  8. O Legrand
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  16. P Raby
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  17. A Buzyn
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  18. S Caillères
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  19. S Darre
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  20. C Fohrer
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  21. A Sonet
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  22. C Bilhou-Nabera
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  23. M-C Béné
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  24. H Dombret
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  25. P Berthaud
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  26. X Thomas
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for the Group for Research in Adult Acute Lymphoblastic Leukemia (GRAALL)

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Correspondence to A Delannoy.

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Delannoy, A., Delabesse, E., Lhéritier, V. et al. Imatinib and methylprednisolone alternated with chemotherapy improve the outcome of elderly patients with Philadelphia-positive acute lymphoblastic leukemia: results of the GRAALL AFR09 study. Leukemia 20, 1526–1532 (2006). https://doi.org/10.1038/sj.leu.2404320

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  • DOI: https://doi.org/10.1038/sj.leu.2404320

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