Allogeneic stem cell transplantation for patients with Philadelphia positive leukemia resistant to imatinib

Abstract

To investigate the effect of allogeneic hemopoietic stem cell transplantation (HSCT) in patients with acute lymphocytic leukemia (ALL) or chronic myelocytic leukemia (CML) resistant to imatinib mesylate (IM). Fourteen patients with ALL [n=4, all with Ph (+) chromosome] or CML (n=10, 1 in acceleration phase and 4 in blastic crisis) resistant to IM received allogeneic HSCT. The hematopoietic stem cells transplanted to 7 cases were from identical sibling donors, and hematopoietic stem cells transplanted to the other 7 were from mismatched related donors. Eight cases received recombinant human granulocyte-colony stimulating factor (rhG-CSF) mobilized bone marrow transplantation plus peripheral blood stem cell transplantation (PBSCT), and 6 only received PBSCT. Ten cases were given rhG-CSF mobilized donor lymphocyte infusion (DLI) to prevent or treat relapsing. All patients achieved complete allogeneic engraftment and the median times of neutrophil recovery and platelet recovery were 16 and 13 days respectively. There was no treatment related death. Nine of the 14 patients developed acute graft versus host disease (GVHD), 7 being in the grade II and 2 being in grade III; and 6 of the 13 evaluable patients developed extensive chronic GVHD. The hematological relapse was 9. Allo-HSCT can be an important salvage option for patients with Ph (+) chromosome with leukemia resistant to IM.