医学
甲磺酸伊马替尼
内科学
微小残留病
急性淋巴细胞白血病
维持疗法
外科
养生
伊马替尼
移植
挽救疗法
长春新碱
胃肠病学
费城染色体
化疗
环磷酰胺
白血病
髓系白血病
淋巴细胞白血病
生物化学
化学
染色体易位
基因
作者
Naval Daver,Deborah A. Thomas,Farhad Ravandi,Jorge E. Cortés,Rebecca Garris,Elias Jabbour,Guillermo Garcia‐Manero,Gautam Borthakur,Tapan M. Kadia,Michael Rytting,Marina Konopleva,Hagop M. Kantarjian,Susan O’Brien
出处
期刊:Haematologica
[Ferrata Storti Foundation]
日期:2015-02-14
卷期号:100 (5): 653-661
被引量:169
标识
DOI:10.3324/haematol.2014.118588
摘要
We have previously reported on the efficacy and tolerability of hyper-CVAD regimen (cyclophosphamide, vincristine, Adriamycin, and dexamethasone) and imatinib followed by imatinib-based consolidation/maintenance therapy in 20 patients with newly diagnosed Philadelphia-positive acute lymphoblastic leukemia. Here, we present the 13-year follow up of our study. Fifty-four patients with newly diagnosed Philadelphia-positive acute lymphoblastic leukemia were enrolled: 39 (72%) with de novo disease, 6 (11%) whose disease was primary refractory after induction (without a tyrosine kinase inhibitor), and 9 (17%) in complete remission after one course of induction therapy (without tyrosine kinase inhibitor). Forty-two (93%) of the 45 patients treated for active disease achieved complete remission, one achieved complete remission with incomplete recovery of platelets, one achieved partial remission and one died during induction. Nineteen (35%) patients are alive and 18 are in complete remission. The 5-year overall survival rate for all patients was 43%. Significant negative predictors of overall survival were age over 60 years, p190 molecular transcript, and active disease at enrollment. Sixteen (30%) patients underwent allogeneic stem cell transplantation. Median overall survival was not significantly greater for patients who underwent transplant. Patients with residual molecular disease at three months had improved complete remission duration with transplant. The median time to hematologic recovery and severe toxicities with combination were not significantly different from those observed with conventional chemotherapy. Only one patient discontinued therapy due to toxicity. HyperCVAD chemotherapy and imatinib is an effective regimen for Philadelphia-positive acute lymphoblastic leukemia. Transplant may not be indicated in all patients with Philadelphia-positive acute lymphoblastic leukemia. (clinicaltrials.gov identifier: NCT00038610)
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