Abstract
The Japan Adult Leukemia Study Group (JALSG) Ph+ALL202 study reported a high complete remission (CR) rate for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) patients treated with imatinib-combined chemotherapy. However, the long-term treatment efficacy remains uncertain. Here, we report a final analysis of the JALSG Ph+ALL202 study. The outcomes were compared with those of the JALSG ALL93 and ALL97 studies, which were conducted in the pre-imatinib era. Ninety-nine newly diagnosed Ph+ALL patients were enrolled in Ph+ALL202 (median age, 45 years; median follow-up, 4.5 years). CR was achieved in 96/99 (97%) patients. Fifty-nine of these 96 patients (61%) underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in their first CR (CR1). The 5-year overall and disease-free survival (DFS) rates were 50 and 43%, respectively, which were significantly higher compared to those in the pre-imatinib era (15 and 19%, respectively). Multivariate analysis revealed that imatinib administration, allo-HSCT in CR1, and a white blood cell count < 30 × 109/L were favorable independent prognostic factors for long-term DFS. Improved odds of receiving allo-HSCT and a lower relapse rate leaded to good long-term outcomes. The 3-year DFS tended to be higher in PCR-negative than that in PCR-positive patients (29 vs. 14%) in the non-HSCT patients, and this tendency was also seen in the allo-HSCT patients (59 vs. 50%). The higher rate of CR upon imatinib use may have contributed to these improvements.
Highlights
Imatinib, a potent inhibitor of the BCR-ABL1 tyrosine kinase, possesses strong anti-leukemic activities for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL)
The minimal residual disease (MRD) at the time of allo-HSCT was evaluated by quantitative-polymerase chain reaction (PCR) within 30 days prior to transplantation
From December 1993 to February 1997, 263 patients were enrolled in Japan Adult Leukemia Study Group (JALSG) ALL93, with 43 patients diagnosed with Ph+ALL
Summary
A potent inhibitor of the BCR-ABL1 tyrosine kinase, possesses strong anti-leukemic activities for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Extended author information available on the last page of the article allogeneic hematopoietic stem cell transplantation (alloHSCT). At this time, the complete remission (CR) was 60–70%, the relapse rate was high if allo-HSCT was not performed [2, 3]. In 2002, the Japan Adult Leukemia Study Group (JALSG) studied imatinib-combined chemotherapy for newly diagnosed Ph+ALL patients (the Ph+ALL202 study) and found a high CR rate for the initial 80 patients [4, 5]. Several groups have reported similar results [6,7,8,9,10,11], the longterm prognosis of patients receiving imatinib-combined chemotherapy remains unclear and is still a major concern
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