WACHOWIAK-J-Białaczki, zespół mielodysplastyczny - Klinika ...

Failure
Suboptimal
Response
Optimal
Response
PAED
II
3 Months
No haematol.
Response
No complete
haematological
remission (CHR)
1 – 2 log reduction
in the
number of BCR-
ABL transcripts
Suttorp-M-EBMT Paed WP Poznan, 2008
Criteria for response assessment of CML
treated with imatinib
Duration of imatinib therapy
6 Months
> 95 % Ph+
35 – 95 % Ph+
< 35 % Ph+
12 Months
> 35 % Ph+
1 – 35 % Ph+
< 0 % Ph+ (CCyR)
< 3 log reduction
in the
number of BCR-
ABL transcripts
18 Months
< 35 % – 1 % Ph+
0 % Ph+ (CCyR)
< 3 log reduction
in the
number of BCR-
ABL transcripts
0 % Ph+ (CCyR)
> = 3 log reduction
in the
number of BCR-
ABL transcripts
No additional cytogenetic aberration except Ph+ !
Stem cell transplantation for chronic myeloid leukemia in children
Cwynarski K, Roberts IAG, Iacobelli S i wsp.
w imieniu EBMT PDs WP oraz EBMT CL WP
Blood 2003; 102: 1224-1231
95 ośrodków
EBMT
OKRES LICZBA
DZIECI
MSD 1985-2001 182
MUD 1985-2001 132
OKRES
OBSERWACJI
(mediana)
1 – 202
miesiące
(49 mies.)
1 – 193
miesiące
(21 mies.)
pLFS
po 3 latach
CP1 63%
AP 35%
CP1 56%
AP 34%
pOS
po 3 latach
CP1 75%
AP 46%
CP1 65%
AP 39%
CML in
chronic phase
CML in advanced
phase (AC / BC)
medium / high dose
imatinib up-front
primary
failure of
imatinib
ALL- or AMLbased
induction
therapy
PAED
II
response
Algorithms for combining Imatinib and SCT in pediatrics
standard dose
imatinib up-front
primary failure
of imatinib
!!! Monitoring !!!
ongoing
response
maximal duration of treatment
2 years
yes
perfectly HLA-matched donor
(either sibling or unrelated;
9-10/10 alleles, high res. typing)
urgent stem cell transplantation
accepting also partially HLAmatched
donors
no
secondary failure
of imatinib
recommend stem
cell transplantation
continue imatinib as
long as effective
Interferon-alpha or 2nd
generation TK-inhibitor
Suttorp-M-EBMT Paed WP Poznan, 2.- 4. 06. 2008
ZESPÓŁ
MIELODYSPLASTYCZNY
(myelodysplastic syndrome, MDS)