Hematopoietic stem cell transplantation in chronic lymphocytic leukemia: a report of 12 patients from a single institution.
BACKGROUND
Stem-cell transplantation is a reasonable therapeutic approach for younger patients with high-risk CLL.


METHODS
Twelve patients (seven males; median age 47 years, range 29-51) with high-risk CLL underwent transplantation (allo, n = 7; auto, n = 5). The conditioning regimen consisted of cyclophosphamide and total body irradiation in 11 patients, and BEAC in the remaining one. Minimal residual disease (MRD) was assessed by cytofluorometry and PCR.


RESULTS
All 11 evaluable patients engrafted. Of the seven allografted patients, two died of treatment-related causes; three patients developed acute GVHD. No transplant-related mortality was observed in autografted patients. After transplantation, 10 of 11 patients evaluable for response achieved CR (91%; 95% CI 59%-100%) which was molecular in nine patients (82%; 95% CI 48%-98%). One patient in CR but MRD+ relapsed nine months after transplantation and died. Seven patients remain in molecular CR for a median of 16 months (range 1-58). Estimated actuarial survival and disease-free survival at two years is 81% (95% CI 43%-100%) and 71% (95% CI 43%-99%), respectively. Relapse risk at two years is 12.5% (95% CI 0%-35.5%).


CONCLUSIONS
Patients with high-risk CLL can achieve long-lasting molecular CR after SCT. The role of transplants in CLL management deserves investigation in controlled trials.
Esteve
J
J
Department of Hematology, University of Barcelona, Spain. jesteve@medicina.ub.es
Villamor
N
N
Colomer
D
D
Bosch
F
F
López-Guillermo
A
A
Rovira
M
M
Urbano-Ispizua
A
A
Sierra
J
J
Carreras
E
E
Montserrat
E
E
D000328:Adult; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005434:Flow Cytometry; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014916:Whole-Body Irradiation
D003520:Cyclophosphamide