Efficacy of imatinib maintenance after stem cell transplantation for Ph+/BCR::ABL1 positive ALL: long-term outcome of a randomized trial and impact of peritransplant minimal residual disease
In brief
Imatinib after transplant gives comparable 10-year relapse rates (14% vs 18%)
In a randomized trial of Philadelphia-positive ALL patients, giving imatinib prophylactically versus starting it only when minimal residual disease was detected resulted in similar 10-year outcomes: relapse 14% versus 18%, non-relapse mortality around 12%, and overall survival near 70%. The data support flexible, MRD-guided imatinib maintenance after stem-cell transplantation.
- Journal
- Leukemia & lymphoma (Q2)
- Published
- 2 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Heike Pfeifer, Wolfgang Bethge, Stefan Schönland, Lisa Heberling, Leo Ruhnke, Michael Stadler, et al.
- PMID
- 42543021
- DOI
- 10.1080/10428194.2026.2707442
Why clinicians should know about it
- Picked for Hematology (paper of the day, 3 August 2026).
- Picked for Transplantation (paper of the day, 3 August 2026): Recent Transplantation research from a high-quartile journal
Abstract
Tyrosine kinase inhibitors are recommended as maintenance therapy following allogeneic stem cell transplantation (HSCT) for Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL), but optimal medication, dose, and duration remain a subject of ongoing study. We provide the final analysis of a prospective randomized trial comparing prophylactic and minimal residual disease (MRD)-triggered imatinib maintenance. The two patient cohorts did not differ significantly in terms of cumulative incidence of relapse (CIR; 14% vs. 18%), non-relapse mortality (NRM; 12% vs. 11%), leukemia-free survival (LFS) 64% vs. 69%, and overall survival (OS) at 10 years (68% vs. 71%). Endpoints were assessed every 6 weeks within the trial from 4 weeks after SCT until EOS at week 55 and after that according to local standards. In summary, this provides a framework for MRD-based treatment of patients for maintenance after HSCT with excellent long-term outcome after 10 years in both groups.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.