title: Outcome of allogeneic stem cell transplantation for B cell chronic lymphocytic leukemia.
abstract: The objective of this study was to describe the outcome of allogeneic stem cell transplantation (alloSCT) in a series of patients with B cell chronic lymphocytic leukemia (B-CLL). Twenty-three B-CLL patients were transplanted between 1988 and 1997 using stem cells from a related (n = 20) or an unrelated donor (n = 3). The median age of the patients was 46 years, and the median number of prior chemotherapy regimens received was two. At transplantation, 14 patients had chemorefractory disease and 12 of these were refractory to fludarabine. The preparative regimens included total body irradiation (TBI) in 22 of the 23 cases. All patients received graft-versus-host disease (GVHD) prophylaxis with cyclosporine and methotrexate. Twenty patients (87%) achieved a complete remission (CR). The incidence of grade II-IV acute GVHD was 54%. Fourteen (61%) patients are alive and disease-free, including two with unrelated donors, at a median of 26 months (range, 9-115 months). Nine patients (39%) have died, one of whom had progressive B-CLL. The only favorable prognostic factor for failure-free survival (FFS) and overall survival (OS) after alloSCT was the use of a cyclophosphamide/TBI rather than an etoposide/cyclophosphamide/TBI regimen (P = 0.03). The projected 5-year FFS, OS, and relapse rates after alloSCT were 65% (95% CI, 48-88%), 62% (95% CI, 43-88%), and 5% (95%, CI 0-13%), respectively. These findings demonstrate the potential of high-dose therapy and alloSCT for inducing and maintaining a remission in patients with advanced or chemorefractory B-CLL. The low relapse rate may be due to an allogeneic graft-versus-leukemia effect.
authors.affiliation: Department of Internal Medicine, Section of Oncology and Hematology, University of Nebraska Medical Center, Omaha, Nebraska 68198-3330, USA.
authors.forename: Z S
authors.initials: ZS
authors.lastname: Pavletic
authors.forename: E R
authors.initials: ER
authors.lastname: Arrowsmith
authors.forename: P J
authors.initials: PJ
authors.lastname: Bierman
authors.forename: S A
authors.initials: SA
authors.lastname: Goodman
authors.forename: J M
authors.initials: JM
authors.lastname: Vose
authors.forename: S R
authors.initials: SR
authors.lastname: Tarantolo
authors.forename: R S
authors.initials: RS
authors.lastname: Stein
authors.forename: G
authors.initials: G
authors.lastname: Bociek
authors.forename: J P
authors.initials: JP
authors.lastname: Greer
authors.forename: C D
authors.initials: CD
authors.lastname: Wu
authors.forename: J P
authors.initials: JP
authors.lastname: Kollath
authors.forename: D D
authors.initials: DD
authors.lastname: Weisenburger
authors.forename: A
authors.initials: A
authors.lastname: Kessinger
authors.forename: S N
authors.initials: SN
authors.lastname: Wolff
authors.forename: J O
authors.initials: JO
authors.lastname: Armitage
authors.forename: M R
authors.initials: MR
authors.lastname: Bishop
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome