Zhao, Y., Tan, Y., Wu, G., Liu, L., Wang, Y., Luo, Y., . . . Huang, H. (2011). Berbamine overcomes imatinib-induced neutropenia and permits cytogenetic responses in Chinese patients with chronic-phase chronic myeloid leukemia. International Journal of Hematology, 94, 156–162.
The purpose of this study was to investigate whether berbamine has clinical benefit in reversing imatinib-related neutropenia. Berbamine is an alkaloid derived from the Berberis aristata plant that has been used in China for managing leukopenia associated with cancer and chemotherapy.
Patients self-selected, with consultation with their doctors, which treatment approach they wanted to have.
In patients who did not receive berbamine, the imatinib dose was adjusted according to guidelines so that those who developed an absolute neutrophil count (ANC) of less than 1.0 x 109/L had imatinib withheld until their ANC was 1.5 x 109/L or higher.
In the berbamine group, a daily dose of 336 mg orally was given to patients who developed grade 2 neutropenia (between the above 2 ANC levels) to prevent development of grade 3 or above. If grade 3 or above, the patients had imatinib withheld until they recovered to grade 1 or lower, and berbamine was continued until they had a stable count of an ANC of 2 x 109/L or greater for more than four weeks.
A single-site setting in China
Active antitumor treatment
Non-randomized two group comparison
Twenty patients chose to use berbamine and were treated preemptively. Incidence of grade 3 or higher neutropenia was 15% in the berbamine group and 38.5% in the comparison group—which was not a statistically significant difference.
Recovery time for patients treated with berbamine was a median of 42 days compared to 79 days in controls (p = 0.043). There was no difference between groups in disease response to treatment rates. The only adverse events with berbamine reported were symptoms of nausea in two patients.
Berbamine appears to be well tolerated by these patients overall. No firm conclusions can be drawn from this study.
Berbamine, a naturally occurring alkaloid compound from a Chinese traditional plant, may have some applicability and benefit for patients receiving imatinib for chronic myeloid leukemia. This particular study does not provide strong support for this use due to numerous study limitations. Further well-designed research with appropriate sample sizes in these types of patients, as well as other groups at risk for development of severe neutropenia, is warranted.