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

Article metrics


We studied 128 patients with chronic myeloid leukemia (CML) relapsing after allogeneic stem cell transplantation (SCT). Disease at the time of treatment with Imatinib was in chronic phase (CP) in 51 patients, accelerated phase (AP) in 31 and blastic crisis (BC) in 46. Of the 51 patients in CP, 14 were in cytogenetic and two in molecular relapses. The median interval between relapse and Imatinib therapy was 5 months (0–65). A total of 50 patients had failed treatment with donor lymphocyte infusions prior to Imatinib. The overall hemato-logical response rate was 84% (98% for patients relapsing in CP). The complete cytogenetic response (CCR) was 58% for patients in CP, 48% for AP and 22% for patients in BC. Complete molecular responses were obtained in 25 patients (26%), of whom 21 were in CP or AP. With a median follow-up of 9 months, the estimated 2-year survival for CP, AP and BC patients was 100, 86 and 12%, respectively. Out of 79 evaluable patients, 45 (57%) achieved full donor and 11 (14%) mixed chimerism after Imatinib. We conclude that Imatinib has significant activity against CML in relapse after allogeneic SCT. Durable cytogenetic and molecular remissions are obtainable in patients in CP.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1


  1. 1

    van Rhee F, Szydlo RM, Hermans J, Devergie A, Frassoni F, Arcese W et al. Long-term results after allogeneic bone marrow transplantation for chronic myelogenous leukemia in chronic phase: a report from the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 1997; 20: 553–560.

  2. 2

    Guglielmi C, Arcese W, Hermans J, Bacigalupo A, Bandini G, Bunjes D et al. Risk assessment in patients with Ph+ chronic myelogenous leukemia at first relapse after allogeneic stem cell transplant: an EBMT retrospective analysis. The Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Blood 2000; 95: 3328–3334.

  3. 3

    Kolb HJ, Schattenberg A, Goldman JM, Hertenstein B, Jacobsen N, Arcese W et al. Graft-versus-leukemia effect of donor lymphocyte transfusions in marrow grafted patients. European Group for Blood and Marrow Transplantation Working Party Chronic Leukemia. Blood 1995; 86: 2041–2050.

  4. 4

    Dazzi F, Szydlo RM, Cross NC, Craddock C, Kaeda J, Kanfer E et al. Durability of responses following donor lymphocyte infusions for patients who relapse after allogeneic stem cell transplantation for chronic myeloid leukemia. Blood 2000; 96: 2712–2716.

  5. 5

    Griffin J . The biology of signal transduction inhibition: basic science to novel therapies. Semin Oncol 2001; 28 (Suppl. 17): 3–8.

  6. 6

    Druker BJ, Lydon NB . Lessons learned from the development of an abl tyrosine kinase inhibitor for chronic myelogenous leukemia. J Clin Invest 2000; 105: 3–7.

  7. 7

    Druker BJ, Tamura S, Buchdunger E, Ohno S, Segal GM, Fanning S et al. Effects of a selective inhibitor of the Abl tyrosine kinase on the growth of Bcr-Abl positive cells. Nat Med 1996; 2: 561–566.

  8. 8

    Druker BJ, Sawyers CL, Kantarjian H, Resta DJ, Reese SF, Ford JM et al. Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N Engl J Med 2001; 344: 1038–1042.

  9. 9

    Kantarjian H, Sawyers C, Hochhaus A, Guilhot F, Schiffer C, Gambacorti-Passerini C et al. The International STI571 CML Study Group. Hematologic and cytogenetic responses to imatinib mesylate in chronic myelogenous leukemia. N Engl J Med 2002; 346: 645–652.

  10. 10

    Druker BJ, Talpaz M, Resta DJ, Peng B, Buchdunger E, Ford JM et al. Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N Engl J Med 2001; 344: 1031–1037.

  11. 11

    Talpaz M, Silver RT, Druker BJ, Goldman JM, Gambacorti-Passerini C, Guilhot F et al. Imatinib induces durable hematologic and cytogenetic responses in patients with accelerated phase chronic myeloid leukemia: results of a phase 2 study. Blood 2002; 99: 1928–1937.

  12. 12

    Ottmann OG, Hoelzer D . The ABL tyrosine kinase inhibitor STI571 (Glivec) in Philadelphia positive acute lymphoblastic leukemia. Hematol J 2002; 3: 2–6.

  13. 13

    Sawyers CL, Hochhaus A, Feldman E, Goldman JM, Miller CB, Ottmann OG et al. Imatinib induces hematologic and cytogenetic responses in patients with chronic myelogenous leukemia in myeloid blast crisis: results of a phase II study. Blood 2002; 99: 3530–3539.

  14. 14

    Wassmann B, Klein SA, Scheuring U, Pfeifer H, Martin H, Gschaidmeier H et al. Hematologic and cytogenetic remission by STI571 (Glivec) in a patient relapsing with accelerated phase CML after second allogeneic stem cell transplantation. Bone Marrow Transplant 2001; 28: 721–724.

  15. 15

    Thambi P, Sausville EA . STI571 (Imatinib mesylate): the tale of a targeted therapy. Anticancer Drugs 2002; 13: 111–114.

  16. 16

    Kantarjian HM, O'Brien S, Cortes JE, Giralt SA, Rios MB, Shan J et al. Imatinib mesylate therapy for relapse after allogeneic stem cell transplantation for chronic myelogenous leukemia. Blood 2002; 100: 1590–1595.

  17. 17

    Olavarria E, Craddock C, Dazzi F, Marin D, Marktel S, Apperley JF et al. Imatinib mesylate (STI571) in the treatment of relapse of chronic myeloid leukemia after allogeneic stem cell transplantation. Blood 2002; 99: 3861–3862.

  18. 18

    McCann SR, Gately K, Conneally E, Lawler M . Molecular response to Imatinib Mesylate following relapse after allogeneic SCT for CML. Blood 2003; 101: 1200–1201.

  19. 19

    Dazzi F, Szydlo RM, Craddock C, Cross NC, Kaeda J, Chase A et al. Comparison of single-dose and escalating-dose regimens of donor lymphocyte infusion for relapse after allografting for chronic myeloid leukemia. Blood 2000; 95: 67–71.

  20. 20

    Apperley JF, Jones L, Hale G, Waldmann H, Hows J, Rombos Y et al. Bone marrow transplantation for patients with chronic myeloid leukaemia: T-cell depletion with Campath-1 reduces the incidence of graft-versus-host disease but may increase the risk of leukaemic relapse. Bone Marrow Transplant 1986; 1: 53–66.

  21. 21

    O'Brien SG, Guilhot F, Larson RA, Gathmann I, Baccarani M, Cervantes F et al. IRIS Investigators. N Engl J Med 2003; 348: 994–1004.

  22. 22

    Goldman JM, Druker B . Chronic myeloid leukemia: current treatment options. Blood 2001; 98: 2039–2042.

  23. 23

    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.

Download references


List of participating centers: Univ. Klinik fur Innere Medizin I, Vienna (Lechner); Princess Margaret Hospital, Toronto (Lipton); Chaim Sheba Medical Center, Tel Hashomer (Nagler); Hospital Virgen del rocio, Sevilla (Parody); University ‘La Sapienza’, Rome (Guglielmi); Azienda Ospedaliera ‘Bianchi-Melacrino-Morelli’, Reggio-Calabria (Iacopino); Institute of Hematology and Blood Transfusion, Prague (Vitek); Hôpital St Louis, Paris (Rousselot); University Hospital, Olomouc (Indrak, Faber); Nottingham City Hospital, Nottingham (Byrne); Royal Victoria Infirmary, Newcastle (O'Brien); Hotel Dieu, Nantes (Harousseau); III Med Klinik der TU Klinkum Rechts der Isar, München (Schneller); Johannes Gutenberg-Universität, Mainz (Fischer); Hospital de La Princesa, Madrid (Steegman); Hopital E Herriot, Lyon (Michallet); Hammersmith Hospital, London (Olavarria); Royal Liverpool University Hospital, Liverpool (Clark); University of Leipzig, Leipzig (Deininger, Niederwieser); Hadassah University Hospital, Jerusalem (Ben Yehuda); University of Idar-Oberstein, Idar-Oberstein (Basara); Huddinge University Hospital, Huddinge (Ljungman); Universität Frankfurt, Frankfurt (Ottmann); Bristol Royal Hospital for Children, Bristol (Marks); University of Brisbane, Brisbane (Taylor); Hôpital Haut-leveque, Bordeaux (Perreau, Cony-Makhoul); Hospital San Orsola, Bologna (Bandini); Virchow-Klinikum, Berlin (Sieger, Le Coutre); Kantonsspital, Basel (Hechm); Hospital Clinic, Barcelona (Cervantes); Royal Adelaide Hospital, Adelaide (Hughes); Grampian University Hospitals, Aberdeen (Culligan).

Author information

Correspondence to E Olavarria.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Olavarria, E., Ottmann, O., Deininger, M. et al. Response to imatinib in patients who relapse after allogeneic stem cell transplantation for chronic myeloid leukemia. Leukemia 17, 1707–1712 (2003) doi:10.1038/sj.leu.2403068

Download citation


  • imatinib
  • stem cell transplantation
  • CML
  • relapse

Further reading