High-dose imatinib mesylate combined with vincristine and dexamethasone (DIV regimen) as induction therapy in patients with resistant Philadelphia-positive acute lymphoblastic leukemia and lymphoid blast crisis of chronic myeloid leukemia

摘要: Imatinib combined with high-dose chemotherapy is now becoming the gold standard for treatment of Philadelphia chromosome-positive acute leukemias. However, in all studies imatinib dosage was tapered to 400-600 mg per day. We decided initiate a clinical trial evaluate an opposite strategy based on (800 day) less intensive chemotherapeutic regimen (vincristine and dexamethasone), which we called DIV induction regimen. Thirty-one patients (18 relapsing or refractory Ph+ lymphoblastic leukemias 13 lymphoid blast crisis chronic myelogenous leukemias) were enrolled. Complete remission (CR) obtained 28 out 30 assessable patients. The median bcr-abl/abl ratio after course 0.1%. Median time neutrophil recovery 21 days. Fungus infections observed six 31 possibly related dexamethasone. Neuropathy due vincristine noted 14 cases. Nine 19 under 55 years received allogenic stem cell transplantation 78 days post-CR. Patients older than experienced 90% CR rate without additional toxicities, suggesting may also be proposed as front line therapy