Sustained Cytogenetic Remission Induced by Imatinib Mesylate in a Chronic Myeloid Leukemia Patient Who Had a Relapse into Lymphoid Crisis after Allogeneic Hematopoietic Stem Cell Transplantation

Case Report

Abstract

We report on the response to imatinib mesylate in a chronic myeloid leukemia patient who, after undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT) for treatment of lymphoid blastic crisis, had a relapse into blastic crisis despite the presence of chronic and grade II acute graft-versus-host disease (GVHD). Complete hematologic response and the disappearance of the Bcr-Abl fusion signal on fluorescence in situ hybridization analysis were achieved after 10 weeks of imatinib therapy and were maintained for 26 months with no adverse effects, including recurrence of GVHD. This case highlights the ability of imatinib to induce sustained hematologic and cytogenetic remission in some patients who have had relapses into advanced-stage chronic myeloid leukemia after alloHSCT.

Key words

Chronic myeloid leukemia Blastic crisis Allogeneic hematopoietic stem cell transplantation Imatinib mesylate Graft-versus-host disease 

References

  1. 1.
    Goldman JM, Melo JV. Chronic myeloid leukemia: advances in biology and new approaches to treatment. N Engl J Med. 2003;349:1451–1464.PubMedCrossRefGoogle Scholar
  2. 2.
    Dazzi F, Szydlo RM, Craddock C, et al. Comparison of single-dose and escalating-dose regimens of donor lymphocyte infusion for relapse after allografting for chronic myeloid leukemia. Blood. 2000;95:67–71.PubMedGoogle Scholar
  3. 3.
    Kantarjian H, Sawyers C, Hochhaus A, et al. Hematologic and cytogenetic responses to imatinib mesylate in chronic myelogenous leukemia. N Engl J Med. 2002;346:645–652.PubMedCrossRefGoogle Scholar
  4. 4.
    Talpaz M, Silver RT, Druker BJ, et al. Imatinib induces durable hematologic and cytogenetic responses in patients with accelerated phase chronic myeloid leukemia: results of a phase 2 study. Blood. 2002;99:1928–1937.PubMedCrossRefGoogle Scholar
  5. 5.
    Sawyers CL, Hochhaus A, Feldman E, et al. Imatinib induces hematologic and cytogenetic responses in patients with chronic myelogenous leukemia in myeloid blast crisis: results of a phase II study. Blood. 2002;99:3530–3539.PubMedCrossRefGoogle Scholar
  6. 6.
    Kantarjian HM, Cortes J, O’Brien S, et al. Imatinib mesylate (STI571) therapy for Philadelphia chromosome-positive chronic myelogenous leukemia in blast phase. Blood. 2002;99:3547–3553.PubMedCrossRefGoogle Scholar
  7. 7.
    Wassmann B, Scheuring U, Thiede C, et al. Stable molecular remission induced by imatinib mesylate (STI571) in a patient with CML lymphoid blast crisis relapsing after allogeneic stem cell transplantation. Bone Marrow Transplant. 2003;31:611–614.PubMedCrossRefGoogle Scholar
  8. 8.
    Kantarjian HM, O'Brien S, Cortes JE, et al. Imatinib mesylate therapy for relapse after allogeneic stem cell transplantation for chronic myelogenous leukemia. Blood. 2002;100:1590–1595.PubMedGoogle Scholar
  9. 9.
    Savage DG, Antman KH. Imatinib mesylate: a new oral targeted therapy. N Engl J Med. 2002;346:683–693.PubMedCrossRefGoogle Scholar
  10. 10.
    Kantarjian HM, Cortes JE, O'Brien S, et al. Imatinib mesylate therapy in newly diagnosed patients with Philadelphia chromosome- positive chronic myelogenous leukemia: high incidence of early complete and major cytogenetic responses. Blood. 2003;101:97–100.PubMedCrossRefGoogle Scholar
  11. 11.
    Hughes TP, Kaeda J, Branford S, et al. Frequency of major molecular responses to imatinib or interferon alfa plus cytarabine in newly diagnosed chronic myeloid leukemia. N Engl J Med. 2003;349:1423–1432.PubMedCrossRefGoogle Scholar
  12. 12.
    Druker BJ, Sawyers CL, Kantarjian H, et al. Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N Engl J Med. 2001;344:1038–1042.PubMedCrossRefGoogle Scholar
  13. 13.
    Sato N, Narita M, Takahashi M, et al. The effects of STI571 on antigen presentation of dendritic cells generated from patients with chronic myelogenous leukemia. Hematol Oncol. 2003;21:67–75.PubMedCrossRefGoogle Scholar
  14. 14.
    Olavarria E, Ottmann OG, Deininger M, et al. Response to imatinib in patients who relapse after allogeneic stem cell transplantation for chronic myeloid leukemia. Leukemia. 2003;17:1707–1712.PubMedCrossRefGoogle Scholar
  15. 15.
    Sugimoto K, Mikoshiba M, Ohashi K, et al. Imatinib mesylate (Gleevec) in the treatment of 2 patients with Philadelphia-positive ALL relapsing after allogeneic stem cell transplantation. Int J Hematol. 2002;75:440–442.PubMedCrossRefGoogle Scholar
  16. 16.
    Avery S, Nadal E, Whiteway A, et al. Combining immunotherapy and BCR-ABL tyrosine kinase inhibition: reduced intensity conditioning stem cell transplantation followed by imatinib in patients with chronic myeloid leukemia in chronic phase. Blood. 2003;102:3608.Google Scholar

Copyright information

© The Japanese Society of Hematology 2004

Authors and Affiliations

  1. 1.Third Department of Internal MedicineYamaguchi University School of MedicineYamaguchiJapan

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