Should All Newly Diagnosed Patients Be Treated with Imatinib?
This question is frequently asked and opinions still vary. However, there is an inexorable shift toward a trial period of imatinib therapy for most if not all newly diagnosed patients because of the efficacy of imatinib and its minimal morbidity and mortality compared to allografting. As described below, it is now possible to formulate evidence-based criteria that allow the definition of “suboptimal response” to the drug and it is patients with such suboptimal response who might reasonably be offered an allograft. Such an approach can be fairly easily justified for a newly diagnosed 40 year old for whom only a matched unrelated donor is available; however, the decision is much more difficult for a 20 year old with a sibling donor. Although the ongoing response rates with imatinib monotherapy continue to be impressive1 (see below), less than 10% of patients appear to be “disease free” based on polymerase chain reaction (PCR) analysis,2 and there are small numbers of concerning reports o
