# EsPhALL2010: continuous imatinib with chemotherapy in paediatric Philadelphia chromosome-positive ALL

Source: https://onco.cc/key-papers/paper-esphall2010-continuous-imatinib-biondi-lancet-haematol-2018/  
OnCo record `paper-esphall2010-continuous-imatinib-biondi-lancet-haematol-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Giving children with Philadelphia-positive leukaemia the pill imatinib continuously from the second week of treatment allowed fewer of them to need a transplant, with survival similar to the earlier study that used short courses, but at the cost of more serious toxicity during intensive treatment blocks.

## Summary

Prospective, intergroup, open-label, single-arm trial across 11 study groups in Europe, Chile and Hong Kong: 155 patients aged 1 to 17 with Philadelphia chromosome-positive acute lymphoblastic leukaemia received imatinib 300 mg/m2 from day 15 of induction continuously through chemotherapy, with transplant reserved for poor early responders (38 percent were transplanted in first remission).

Five-year event-free survival was 57.0 percent and overall survival 71.8 percent, similar to EsPhALL2004 despite fewer transplants. 154 serious adverse events occurred in 80 patients, mostly infections during high-risk blocks and delayed intensifications, including 14 fatal events.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: The Lancet Haematology
- Year: 2018
- DOI: 10.1016/S2352-3026(18)30173-X
- Authors: Biondi A, Gandemer V, De Lorenzo P, et al.
- Findings: Five-year event-free survival 57.0 percent (95% CI 48.5 to 64.6) and overall survival 71.8 percent (63.5 to 78.5).; 38 percent of patients had transplant in first remission, fewer than in EsPhALL2004, with similar survival.; Serious adverse events in 52 percent of patients, 14 fatal, concentrated in high-risk blocks and delayed intensification.
- What it means: Continuous imatinib from induction lets many children with Philadelphia-positive ALL avoid transplant, but the intensive BFM backbone is toxic; later trials reduced chemotherapy intensity under tyrosine kinase inhibitor cover.
- Caveats: Single-arm design compared with the earlier EsPhALL2004 cohort rather than a concurrent control.

## Sources

- Lancet Haematol 2018: https://doi.org/10.1016/S2352-3026(18)30173-X
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30501871/

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL)](https://onco.cc/cancers/all-paediatric-ph-positive/)
- drugs: [Imatinib](https://onco.cc/drugs/imatinib/)
- trials: [EsPhALL (EsPhALL2004 and EsPhALL2010)](https://onco.cc/trials/esphall/)
- journals: [The Lancet Haematology](https://onco.cc/journals/lancet-haematology/)

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