Cytarabine Induction Followed by Imatinib Post-Induction Therapy in Patients with Acute Myeloid Leukaemia - Limited Effects in a Case Series

Abstract

Elderly patients with acute myeloid leukaemia frequently cannot undergo intensive chemotherapy due to comorbidities. We report a retrospective case series of elderly patients with AML treated with low dose cytarabine induction. Eleven patients with at least 25% of bone marrow blasts expressing c-kit received Imatinib post-induction therapy, 7 patients entered as controls. Haematologic responses were only slightly better in the Imatinib cohort. No correlation of the response to Imatinib with c-kit expression was noted. Partly due to two early deaths in the control cohort, survival was longer in the Imatinib cohort. Imatinib post-induction therapy after cytarabine induction is feasible in elderly patients with AML not eligible for standard induction but responders to Imatinib have only limited benefit from this low-toxic therapy while no predictive response markers could be found.Keywords: Imatinib mesylate, Acute myeloid leukaemia, Post-induction therapy, Elderly patient ÖZET Akut Myeloid Lösemili Hastalarda ‹matinib Post-‹ndüksiyon Sonras› ‹matinib Tedavisi: Vaka Serisinde K›s›tl› EtkiAkut myeloid lösemili (AML) yafll› hastalar komorbidite nedeniyle s›kl›kla yo¤un kemoterapi alamazlar. Bu retrospektif çal›flmam›zda düflük doz cytarabine indüksiyonu alan yafll› AML'li hastalar de¤erlendirilmifltir. Kemik ili¤indeki blastlar›n en az %25'i c-kit pozitif olan onbir hastaya indüksiyon sonras› imatinib verilirken 7 hasta kontrol grubu olarak al›nd›. ‹matinib grubunda hematolojik cevap hafifçe daha üstündü ve c-kit ekspresyonu ile imatinib cevab› aras›nda iliflki saptanmad›. Sa¤ kal›m, imatinib grubunda daha uzundu, bunun k›smen kontrol grubunda iki erken ölüme ba¤l› oldu¤u düflünüldü. Buna göre, citarabine indüksiyonundan sonra imatinib, standart kemoterapi alamayan yafll› AML'li hastalarda uygun görülmektedir. Imatinib'e cevap verenler bu toksisitesi düflük tedaviden çok az yarar gördüler ve cevab› öngörecek herhangi bir belirteç gösterilemedi.Anahtar Kelimeler: ‹matinib mesilat, Akut myeloid lösemi, Post indüksiyon tedavisi, Yafll› hasta ULUSLARARASı HEMATOLOJI-ONKOLOJI DERGISI ARTICLE