Allogeneic Transplantation In Combination With Imatinib

Imatinib mesylate (formerly known as STI-571, Gleevec,™ Novartis AG) is a potent, reversible inhibitor of bcr/abl tyrosine kinase activity.29 When added to induction chemotherapy, this drug has been shown to increase remission rates among Ph+ ALL patients.3031 Similarly, this drug may be effective for relapsed Ph+ ALL.32 By increasing remission rates among newly diagnosed Ph+ ALL patients, the long-term success of allogeneic transplantation may be improved, as disease status at the time of transplantation is a powerful predictor of long-term survival.25 Furthermore, imatinib use may increase the window of opportunity for patients with newly diagnosed or relapsed disease to find suitable allogeneic donors by prolonging remission time. Imatinib has been given to newly diagnosed, refractory or relapsed patients prior to allogeneic transplantation.33-36 At this time, all that can be concluded from this experience is that imatinib therapy prior to transplantation does not impair engraftment of transplanted hematopoietic progenitor cells.33 Since the number of patients reported at this time is limited, estimates of the long-term impact of imatinib use prior to transplantation are difficult to predict. Whether empiric imatinib after transplantation will be effective as a preventative strategy against relapse is also unpredictable.

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