Delannoy A, Delabesse E, Lhéritier V, Castaigne S, Rigal-Huguet F, Raffoux E, Garban F, Legrand O, Bologna S, Dubruille V, Turlure P, Reman O, Delain M, Isnard F, Coso D, Raby P, Buzyn A, Caillères S, Darre S, Fohrer C, Sonet A, Bilhou-Nabera C, Béné M-C, Dombret H, Berthaud P, Thomas X
Department of Hematology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium.
Leukemia. 2006 Sep;20(9):1526-32. doi: 10.1038/sj.leu.2404320. Epub 2006 Jul 13.
Acute lymphoblastic leukemia (ALL) in the elderly is characterized by its ominous prognosis. On the other hand, imatinib has demonstrated remarkable, although transient, activity in relapsed and refractory Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL), which prompted us to assess the use of imatinib in previously untreated elderly patients. ALL patients aged 55 years or older were given steroids during 1 week. Ph+ve cases were then offered a chemotherapy-based induction followed by a consolidation phase with imatinib and steroids during 2 months. Patients in complete response (CR) after consolidation were given 10 maintenance blocks of alternating chemotherapy, including two additional 2-month blocks of imatinib. Thirty patients were included in this study and are compared with 21 historical controls. Out of 29 assessable patients, 21 (72%, confidence interval (CI): 53-87%) were in CR after induction chemotherapy vs 6/21 (29%, CI: 11-52%) in controls (P=0.003). Five additional CRs were obtained after salvage with imatinib and four after salvage with additional chemotherapy in the control group. Overall survival (OS) is 66% at 1 year vs 43% in the control group (P=0.005). The 1-year relapse-free survival is 58 vs 11% (P=0.0003). The use of imatinib in elderly patients with Ph+ ALL is very likely to improve outcome, including OS.
老年急性淋巴细胞白血病（ALL）的特点是预后凶险。另一方面，伊马替尼已在复发和难治性费城染色体阳性急性淋巴细胞白血病（Ph+ ALL）中显示出显著（尽管是短暂的）活性，这促使我们评估伊马替尼在先前未治疗的老年患者中的应用。55岁及以上的ALL患者在1周内给予类固醇。然后，Ph+阳性病例接受基于化疗的诱导治疗，随后在2个月内接受伊马替尼和类固醇巩固治疗。巩固治疗后达到完全缓解（CR）的患者接受10个周期的交替化疗维持治疗，包括另外两个2个月的伊马替尼治疗周期。本研究纳入了30例患者，并与21例历史对照进行比较。在29例可评估患者中，诱导化疗后21例（72%，置信区间（CI）：53 - 87%）达到CR，而对照组为6/21例（29%，CI：11 - 52%）（P = 0.003）。伊马替尼挽救治疗后又有5例达到CR，对照组额外化疗后有4例达到CR。1年总生存率（OS）为66%，而对照组为43%（P = 0.005）。1年无复发生存率为58%，而对照组为11%（P = 0.0003）。在老年Ph+ ALL患者中使用伊马替尼很可能改善预后，包括总生存率。
