title: Reduced non-relapse mortality after reduced intensity conditioning in advanced chronic lymphocytic leukemia.
abstract: We studied in 30 patients with progressive or relapsing chronic lymphocytic leukemia (CLL) if hematopoietic stem cell transplantation (HSCT) after conditioning with fludarabine, busulfan and ATG is effective and if treatment related mortality can be reduced compared to myeloablative conditioning regimens. Patients had 15 matched related and 15 matched unrelated donors. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine alone or a combination with "short course" methotrexate or mycophenolate mofetil. The median follow-up is 24 months. At last follow up 11 patients were in complete and 13 in partial remission. Six patients had stable or progressive disease. Late complete remissions occurred up to one year after transplantation and the number of patients with CR is still increasing. Four patients died due to treatment related complications resulting in a probability of treatment-related mortality of 15% (CI 95%, 1% to 29%) at 2 years. The probability of overall survival and progression free survival at two years was 79% and 61%, respectively. In conclusion, HSCT after reduced conditioning may lower the treatment-related toxicity and has the capacity to induce complete remissions.
authors.affiliation: Medical Hospital III, Dept. Hematology/Oncology, Charité-Campus Charité Mitte, Schumannstr. 20-21, 10117 Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schetelig
authors.forename: C
authors.initials: C
authors.lastname: Thiede
authors.forename: M
authors.initials: M
authors.lastname: Bornhäuser
authors.forename: R
authors.initials: R
authors.lastname: Schwerdtfeger
authors.forename: M
authors.initials: M
authors.lastname: Kiehl
authors.forename: J
authors.initials: J
authors.lastname: Beyer
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: M
authors.initials: M
authors.lastname: Hensel
authors.forename: C
authors.initials: C
authors.lastname: Scheffold
authors.forename: A D
authors.initials: AD
authors.lastname: Ho
authors.forename: J
authors.initials: J
authors.lastname: Kienast
authors.forename: A
authors.initials: A
authors.lastname: Neubauer
authors.forename: A R
authors.initials: AR
authors.lastname: Zander
authors.forename: A A
authors.initials: AA
authors.lastname: Fauser
authors.forename: G
authors.initials: G
authors.lastname: Ehninger
authors.forename: W
authors.initials: W
authors.lastname: Siegert
mesh_terms: D002066:Busulfan / Q000008:administration & dosage; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000401:mortality*; D012008:Recurrence; D012074:Remission Induction; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods*; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D007166:Immunosuppressive Agents; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine