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A recent study published in the journal Blood reports that first line treatment with Imatinib (Gleevec®) for certain patients diagnosed with acute lymphoblastic leukemia appears to effectively treat the disease while improving overall survival.

Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow that causes the bone marrow to produce excess amounts of white blood cells (lymphocytes). This type of cancer usually progresses quickly if not treated. There is no cure for ALL, though remission may be achieved in some patients. Once ALL has been diagnosed, tests are performed to further describe the extent of the disease and the prognosis. One of these tests is to determine if the Philadelphia chromosome is present. The abnormal Philadelphia chromosome may appear in certain types of leukemias. Current treatment options for ALL included radiation, chemotherapy and chemotherapy followed by stem cell transplantation. Other treatment options such as biological therapies are being investigated in clinical trials. Gleevec® is a newer agent that is being studied for the treatment of certain types of leukemias. Gleevec interferes with cancerous cell growth by attacking a specific protein produced by the Philadelphia chromosome.

Stem cells are immature blood cells taken from the bone marrow or blood and frozen and stored until the patient has completed high doses of chemotherapy or radiation. Stem cells may be collected from the patient-known as an autologous transplant. An allogeneic transplant uses stem cells from a family member or a non-family member whose cells match the patient’s. Once these treatments are completed, the stem cells are then given back to the patient through an infusion. These cells are then allowed to grow and mature to restore the patient’s blood cells.

In this recent study 29 patients diagnosed with Philadelphia chromosome positive ALL were treated with Gleevec-a new approach in extending the period until the patient required an allogeneic stem cell transplant. Overall results indicate that 23 patients achieved a complete remission and each cycle of treatment produced measurable decreases in their disease. One patient did experience a disease relapse during treatment with Gleevec, and three developed resistance to both chemotherapy and Gleevec. Twenty-five of the patients received transplants during their first complete remission. After an average of 25 months of stem cell transplant follow-up, the three-year estimated likelihood of relapse was 3.8 percent; the probability of death due to complications was 18.7 percent; disease-free survival was 78 percent; and overall survival was 78 percent.

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Researchers concluded that, when compared to historical information, Gleevec as a first line therapy for patients diagnosed with ALL appears to provide a good disease response as well as an improved survival advantage in patients with Philadelphia chromosome-positive disease. Further long-term follow-up is needed to confirm the results of this study.

Reference: Lee S, Kim Y, Min C, et al. The effect of first line imatinib therapy on the outcome of allogeneic stem cell transplantation in adults with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood; 2005; 105: 3449-3457.

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