title: Autologous and allogeneic bone marrow transplantation for chronic lymphocytic leukemia: preliminary results.
abstract: OBJECTIVE
  This study was undertaken to evaluate the feasibility and therapeutic effect of high-dose chemoradiotherapy with autologous or allogeneic bone marrow transplantation (BMT) in patients with advanced chronic lymphocytic leukemia (CLL) who relapse after fludarabine treatment.
  
  
  METHODS
  Twenty-two patients with advanced CLL received high-dose cyclophosphamide, total-body irradiation, and BMT. Eleven patients with relapsed CLL received autologous BMT with marrow collected during a prior fludarabine-induced remission; leukemia cells were depleted from the autologous marrow in seven patients using an anti-CD19 monoclonal antibody and immunomagnetic separation. Eleven patients received allogeneic or syngeneic BMT, seven of whom had refractory Rai stage III or IV disease.
  
  
  RESULTS
  Six autologous transplant recipients achieved a complete remission (CR), four a nodular CR (nCR), and one a partial remission (PR). Two recurred with CLL, and three developed Richter's transformation. Two patients had recurrence of immune cytopenias while in morphologic remission; one of these patients died of cytomegalovirus pneumonia. Six of 11 patients survive in remission 2 to 29 months following BMT. Of the 11 patients who received allogeneic or syngeneic BMT, seven achieved a CR, two a nCR, and one a PR; 10 survive 2 to 36 months following BMT.
  
  
  CONCLUSIONS
  These data indicate that high-dose chemotherapy with allogeneic BMT is effective at producing CRs in patients with CLL. Autologous transplantation in CLL is feasible and is capable of producing remissions in patients with advanced CLL. Further studies are warranted to assess the role of BMT in the treatment of CLL.
authors.affiliation: Division of Medicine, University of Texas M.D. Anderson Cancer Center, Houston.
authors.forename: I F
authors.initials: IF
authors.lastname: Khouri
authors.forename: M J
authors.initials: MJ
authors.lastname: Keating
authors.forename: H M
authors.initials: HM
authors.lastname: Vriesendorp
authors.forename: C L
authors.initials: CL
authors.lastname: Reading
authors.forename: D
authors.initials: D
authors.lastname: Przepiorka
authors.forename: Y O
authors.initials: YO
authors.lastname: Huh
authors.forename: B S
authors.initials: BS
authors.lastname: Andersson
authors.forename: K W
authors.initials: KW
authors.lastname: van Besien
authors.forename: R C
authors.initials: RC
authors.lastname: Mehra
authors.forename: S A
authors.initials: SA
authors.lastname: Giralt
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D018189:Immunomagnetic Separation; D016130:Immunophenotyping; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome