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Reduced-intensity allogeneic transplantation combined with imatinib mesylate for chronic myeloid leukemia in first chronic phase

Leukemia volume 23, pages 1171–1174 (2009)Cite this article

Although imatinib mesylate (Novartis, Switzerland) is currently the most effective drug with low toxicity available for treating patients with chronic myeloid leukemia (CML), approximately 10–15% of early chronic phase (CP) patients will display primary or acquired cytogenetic resistance to imatinib. Even in patients who achieve a complete cytogenetic response, minimal residual disease remains detectable by sensitive PCR techniques, indicating a continued threat of relapse. A further limitation of imatinib is that it does not actually cure CML.1 Continued therapy is required to maintain a clinical response. Allogeneic hematopoietic stem cell transplantation is still regarded as the only curative treatment for CML. Conventional myeloablative regimens have been limited by high rates of transplant-related mortality (TRM), especially in patients of advanced age or with comorbidities. A reduced-intensity conditioning (RIC) regimen has therefore been increasingly used in recent years, with an apparent reduction in early TRM. This approach relies on the post-transplant immune-mediated graft-versus-leukemia (GvL) effect, rather than on intensive pre-transplant conditioning, and thus seems to be especially suitable for CML, in which the GvL effect is uniquely effective. However, relapse after RIC remains an important problem, which could be resolved by post-transplant imatinib therapy.2

To take advantage of both the curative potential of hematopoietic stem cell transplantation and the high efficacy of targeted therapy with imatinib, our center has used an RIC regimen based on busulfan (Bu), fludarabine (Flu) and anti-thymocyte globulin (ATG), combined with pre- and post- transplant imatinib for patients with CML in the first chronic phase (CP1). The purpose of this retrospective study was to evaluate the efficacy and safety of this combination therapy in patients with CML.

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Acknowledgements

The work was funded by the Program from Science and Technology Department of Zhejiang Povince (2008C23047).

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  1. Y Luo and X-Y Lai: These authors contributed equally to this work.

Authors and Affiliations

  1. Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Y Luo, X-Y Lai, Y-M Tan, J-M Shi, Y-M Zhao, X-Y Han, G-F Zheng, X-L Zhu, J Sun, Y-L Zheng, G-Q Wu, J-S He, S-Y Chen, A-Y Jin, W-Z Xie, X-J Ye, Z Cai, M-F Lin & H Huang

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Correspondence to H Huang.

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Luo, Y., Lai, XY., Tan, YM. et al. Reduced-intensity allogeneic transplantation combined with imatinib mesylate for chronic myeloid leukemia in first chronic phase. Leukemia 23, 1171–1174 (2009). https://doi.org/10.1038/leu.2008.401

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