Abstract:
:In this study, we randomly compared high doses of the tyrosine kinase inhibitor imatinib combined with reduced-intensity chemotherapy (arm A) to standard imatinib/hyperCVAD (cyclophosphamide/vincristine/doxorubicin/dexamethasone) therapy (arm B) in 268 adults (median age, 47 years) with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). The primary objective was the major molecular response (MMolR) rate after cycle 2, patients being then eligible for allogeneic stem cell transplantation (SCT) if they had a donor, or autologous SCT if in MMolR and no donor. With fewer induction deaths, the complete remission (CR) rate was higher in arm A than in arm B (98% vs 91%; P = .006), whereas the MMolR rate was similar in both arms (66% vs 64%). With a median follow-up of 4.8 years, 5-year event-free survival and overall survival (OS) rates were estimated at 37.1% and 45.6%, respectively, without difference between the arms. Allogeneic transplantation was associated with a significant benefit in relapse-free survival (hazard ratio [HR], 0.69; P = .036) and OS (HR, 0.64; P = .02), with initial white blood cell count being the only factor significantly interacting with this SCT effect. In patients achieving MMolR, outcome was similar after autologous and allogeneic transplantation. This study validates an induction regimen combining reduced-intensity chemotherapy and imatinib in Ph+ ALL adult patients and suggests that SCT in first CR is still a good option for Ph+ ALL adult patients. This trial was registered at www.clinicaltrials.gov as #NCT00327678.
journal_name
Bloodjournal_title
Bloodauthors
Chalandon Y,Thomas X,Hayette S,Cayuela JM,Abbal C,Huguet F,Raffoux E,Leguay T,Rousselot P,Lepretre S,Escoffre-Barbe M,Maury S,Berthon C,Tavernier E,Lambert JF,Lafage-Pochitaloff M,Lhéritier V,Chevret S,Ifrah N,Dombrdoi
10.1182/blood-2015-02-627935subject
Has Abstractpub_date
2015-06-11 00:00:00pages
3711-9issue
24eissn
0006-4971issn
1528-0020pii
blood-2015-02-627935journal_volume
125pub_type
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