Imatinib therapy of Ph positive acute lymphoblastic leukaemia - 2 case reports

Aim The aim of this works is the presentation of two cases of relapsed Ph positive acute lymphoblastic leukaemia (ALL) to which the tyrosine inhibitor Imatinib (Glivec, Novartis) was applied. This therapy was earlier shown to be very helpful in the treatment of chronic myeloid leukemia. Case discription Case 1: A 17 year old patient with Ph positive T-ALL relapsed after allogenic transplantation of marrow and was treated with Imatinib in escalating doses from 200 to 600 mg per day. After 4 weeks of treatment the blastosis in the marrow had fallen from 96% to 7%. Blasts disappeared from the cerebrospinal fluid. At the same time, progression of hepatic and renal failure related to GVHD was observed. Imatinib withdrawal resulted in relapse, uncontrolled proliferation and the death of the patient. Results Case 2: Imatinib was used in the case of a 45 year old patient with Ph positive null-ALL and a mediastinal tumour. After autologous bone marrow transplantation, Imatinib therapy was begun for maintenance.. Daily doses of the drug amounted to only 200 mg owing to associated gastric complaints. After two months of therapy, an increase in blast cells in the bone marrow to 18% was noted. FLAM chemotherapy was given and complete haematological remission was achieved. Conclusions The cases described illustrate new possibilities in the treatment of Ph positive ALL. It is necessary, however, to conduct clinical trials in larger group of patients for the purposes of establishing optimal dosing, the most suitable phase of the disease in which to begin therapy and possible combinations with chemotherapy.