Optimal central nervous system prophylaxis in Philadelphia chromosome-positive acute lymphoblastic leukemia: collateral damage in the imatinib era?

摘要

In the current era of tyrosine kinase inhibitors (TKIs), about 40% of adult patients with Philadelphia chromosome-positive acute acute lymphoblastic leukemia (Ph + ALL) are disease-free at 3-5 years [1-3]. This is the result of imatinib plus chemotherapy combinations that improve the remission rate and, by reducing the risk of an early relapse, allow significantly more patients to undergo an allogeneic stem cell transplant as a conclusive therapeutic step. Because Ph + ALL prevails in older age groups, many frail patients are excluded from transplant and instead offered TKI-based maintenance, sometimes with beneficial effects [4]. Whatever the policy, it is customary in ALL (and Ph + ATI, is no different in this respect) to flank systemic antileukemic therapy with measures apt to prevent a meningeal recurrence, which is otherwise rather common in this type of malignancy and then invariably fatal [5].