Nilotinib restores long-term full-donor chimerism in Ph-positive acute lymphoblastic leukemia relapsed after allogeneic transplantation.

摘要

The prognosis of adult patients with Ph chromosome-positive ALL (Ph+ ALL) is considered poor with an expected long-term survival of 20% at 10 years while no patients with less than a 3-log reduction in BCR-ABL transcripts were alive at 2 years.1 The combination of imatinib with chemotherapy in the induction therapy regimen had improved the response rate, but had not affected overall survival.2 Allo-SCT is still considered the treatment of choice in adults with this disease, despite the fact that post-SCT relapses are relatively frequent.3 A second allotransplant is rarely successful. Administration of imatinib early after SCT might be an effective approach to prevent recurrence of Ph + ALL, but its feasibility has not been systematically evaluated.4 Second generation-targeted therapies, such as nilotinib (Novartis) and dasatinib (Bristol-Myers Squibb), have been evaluated for Ph+ ALL.5 Nilotinib monotherapy exhibits clinical activity in patients with relapsed/refractory Ph+ ALL with 26% achieving complete hematologic response (median treatment duration 1.8 months)6 while 31% achieved complete hematologic response with dasatinib (follow-up 6 months).