Clinical-patient studies

Journal of Neuro-Oncology

, Volume 85, Issue 2, pp 217-222

First online:

Myelosuppression in patients benefiting from imatinib with hydroxyurea for recurrent malignant gliomas

  • Gaurav D. ShahAffiliated withDepartment of Neurology, Memorial Sloan-Kettering Cancer CenterDepartment of Medicine, Memorial Sloan-Kettering Cancer Center
  • , Joel S. SilverAffiliated withDepartment of Medicine, Saint Francis Hospital and Medical Center
  • , Steven S. RosenfeldAffiliated withDepartment of Neurology, Neurological Institute, Columbia University Medical Center
  • , Igor T. GavrilovicAffiliated withDepartment of Neurology, Memorial Sloan-Kettering Cancer Center
  • , Lauren E. AbreyAffiliated withDepartment of Neurology, Memorial Sloan-Kettering Cancer Center
  • , Andrew B. LassmanAffiliated withDepartment of Neurology, Memorial Sloan-Kettering Cancer Center Email author 

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Abstract

Reports suggest reasonable efficacy and minimal myelosuppression from combination imatinib and hydroxyurea for recurrent malignant glioma. We retrospectively reviewed 16 patients treated with this regimen who were evaluable for toxicity; 14 were also evaluable for response. The incidence of grade 3–4 hematologic toxicity was 25%. The best radiographic response, by Macdonald criteria, was partial response (PR) in three patients (21%), stable disease (SD) in four (29%), and progressive disease (PD) in seven (50%). One patient with a PR developed therapy-limiting hematologic toxicity on day 19 of treatment, progressing to grade 4 on day 64, and persisting until death on day 127 despite discontinuing both drugs. Another patient with PR and two of four patients with SD also developed grade 3 hematologic toxicity. All patients with grade 3–4 hematologic toxicity had disease control (PR or SD) as best radiographic response, whereas none with PD suffered grade 3–4 hematologic toxicity. Combining imatinib with hydroxyurea is effective in some patients with malignant glioma. However, myelosuppression can persist for months after discontinuing the regimen, precluding further chemotherapy. Disease control may also correlate with hematologic toxicity (p = 0.08), suggesting that glioma and marrow stem cells may share a common sensitivity to this chemotherapy regimen.

Keywords

Chemotherapy Glioblastoma Hydroxyurea Imatinib Myelosuppression Stem cells