Work

Outcomes After Allogeneic Hematopoietic Stem Cell Transplantation For Patients With Advanced Chronic Lymphocytic Leukemia

Year: 2010

Type: article

Abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) is a treatment increasingly used for patients with chronic lymphocytic leukemia (CLL). There is no curative treatment for patients with advanced CLL. However, prolonged disease-free survival has been shown in patients after allogeneic HSCT. The aim of the study was to analyze the outcome of patients with CLL treated at our institution with either non-myeloablative (n=12) or myeloablative (n=1) conditioned allogeneic HSCT. Thirteen patients (5 males [5 Caucasian], 8 females [7 Caucasian, 1 Hispanic]) diagnosed with CLL who underwent allogeneic HSCT from related (n=7) and unrelated (n=6) donors between November 1998 and July 2009 were included in this analysis. The median age was 55 (age range 47-75), median interval between diagnosis and HSCT was 1,556 days, and the median number of regimens prior to transplant was 5 (range 2-7). Of the 13 patients, 5 were fludarabine-refractory and 1 was not evaluable (NE). 12 patients received a fludarabine-based non-myeloablative conditioning regimen, while 1 patient received an ablative cyclophosphamide/total body irradiation regimen. Prior to transplant, 4 patients had progressive disease (PD), 6 patients were in partial remission (PR), and 3 patients were in complete remission (CR). Disease status was re-assessed 30 days post allogeneic HSCT. At this time post-transplant, 6 patients were in CR, 4 were in PR, 1 was in stable disease (SD), 1 had PD, and 1 was NE. Thus, at day 30, 11 of the 13 patients improved or were stable. Of the remaining 2 patients, 1 continued to progress and 1 died of multi-organ failure 16 days post transplant. At the time of this report, median times to progression and overall survival were 467 and 1,843 days respectively. The Kaplan-Meier probabilities of progression-free survival (PFS) and overall survival (OS) at three-years were 43% and 84%, and the five-year PFS and OS were 43% and 43%, respectively. Differences in the outcomes were not apparent between matched related and unrelated donors. Our results indicate that long-term survival after allogeneic HSCT can be achieved in heavily pre-treated high-risk CLL patients. This treatment should be offered to patients with matched donors and good performance status that have demonstrated resistance to available chemotherapy and biological therapy regimens.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2009.12.418

Authors: A. Rashed, S. Corringham, J.E. Castro, T.J. Kipps, E.D. Ball

Institution: University of California San Diego

Language: English

Topic: Chronic Lymphocytic Leukemia Research

Subfield: Genetics

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,650