Allogeneic stem cell transplantation for chronic lymphocytic leukemia in the era of novel agents
Year: 2020
Type: article
Study design: Observational Study
Abstract: Although novel agents (NAs) have improved outcomes for patients with chronic lymphocytic leukemia (CLL), a subset will progress through all available NAs. Understanding outcomes for potentially curative modalities including allogeneic hematopoietic stem cell transplantation (alloHCT) following NA therapy is critical while devising treatment sequences aimed at long-term disease control. In this multicenter, retrospective cohort study, we examined 65 patients with CLL who underwent alloHCT following exposure to ≥1 NA, including baseline disease and transplant characteristics, treatment preceding alloHCT, transplant outcomes, treatment following alloHCT, and survival outcomes. Univariable and multivariable analyses evaluated associations between pre-alloHCT factors and progression-free survival (PFS). Twenty-four-month PFS, overall survival (OS), nonrelapse mortality, and relapse incidence were 63%, 81%, 13%, and 27% among patients transplanted for CLL. Day +100 cumulative incidence of grade III-IV acute graft-vs-host disease (GVHD) was 24%; moderate-severe GVHD developed in 27%. Poor-risk disease characteristics, prior NA exposure, complete vs partial remission, and transplant characteristics were not independently associated with PFS. Hematopoietic cell transplantation-specific comorbidity index independently predicts PFS. PFS and OS were not impacted by having received NAs vs both NAs and chemoimmunotherapy, 1 vs ≥2 NAs, or ibrutinib vs venetoclax as the line of therapy immediately pre-alloHCT. AlloHCT remains a viable long-term disease control strategy that overcomes adverse CLL characteristics. Prior NAs do not appear to impact the safety of alloHCT, and survival outcomes are similar regardless of number of NAs received, prior chemoimmunotherapy exposure, or NA immediately preceding alloHCT. Decisions about proceeding to alloHCT should consider comorbidities and anticipated response to remaining therapeutic options.
Source: Blood Advances
Authors: Lindsey E. Roeker, Peter Dreger, Jennifer R. Brown, Oscar B. Lahoud, Toby A. Eyre, Danielle M. Brander, Alan Skarbnik, Catherine C. Coombs, Haesook T. Kim, Matthew Davids, Steven T. Manchini, Gemlyn George, Nirav Shah, Timothy J. Voorhees, Kim H. Orchard, Harriet S. Walter, Arvind K. Arumainathan, Andrea Sitlinger, Jae H. Park, Mark B. Geyer, Andrew D. Zelenetz, Craig S. Sauter, Sergio A. Giralt, Miguel-Angel Perales, Anthony R. Mato
Institutions: Memorial Sloan Kettering Cancer Center, Heidelberg University, Dana-Farber Cancer Institute, Churchill Hospital, Oxford University Hospitals NHS Trust, Duke Medical Center, Novant Health, University of North Carolina at Chapel Hill, Harvard University, Medical College of Wisconsin, University Hospital Southampton NHS Foundation Trust, Leicester Royal Infirmary, Clatterbridge Cancer Centre NHS Foundation Trust
Language: English
Subfield: Genetics (clinical)
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
Funders: Lymphoma Research Foundation, Abbott Laboratories, Amgen, Bristol-Myers Squibb, Pfizer, AstraZeneca, Sanofi, Gilead Sciences, Teva Pharmaceutical Industries, Spectrum Pharmaceuticals, Celgene, Exelixis, Cidara Therapeutics, Jazz Pharmaceuticals, TG Therapeutics, Sunesis, American Society for Transplantation and Cellular Therapy, MEI Pharma, Adaptive Biotechnologies, BeiGene, Incyte, Omeros Corporation, Ascentage Pharma, National Institute for Health and Care Research, University of Oxford, Servier, MorphoSys, National Institutes of Health, Genentech, Kite Pharma, Pharmacyclics, Juno Therapeutics, National Cancer Institute
OpenAlex ID: W3080675765