title: The prognostic impact of autologous stem cell transplantation in patients with chronic lymphocytic leukemia: a risk-matched analysis based on the VH gene mutational status.
abstract: To assess the therapeutic value of sequential high-dose therapy (SHDT) including autologous stem cell transplantation in chronic lymphocytic leukemia (CLL) we performed a risk-matched comparison between 66 patients who had undergone a uniform SHDT regimen and a database of 291 patients treated conventionally. Matching variables were age, Binet stage, IgVH (variable region of the immunoglobulin heavy chain) gene mutational status, and lymphocyte count. Forty-four pairs fully matched for all 4 variables were identified. Patient groups were well balanced for additional risk factors including adverse genomic abnormalities and CD38 expression. With an overall median follow-up time of 70 and 86 months, respectively, survival was significantly longer for the SHDT patients than for the conventionally treated patients when calculated from diagnosis (hazard ratio [HR] 0.39; P=.03 [log rank]) or from study entry (HR 0.32; P=.006). The benefit for the SHDT group remained significant when the analyses were restricted to those 58 patients who had an unmutated VH status. Cox regression analysis confirmed SHDT as independent favorable prognostic factor for survival from diagnosis (HR 0.38, P=.04) as well as from study entry (HR 0.38, P=.03). These data suggest a survival benefit for patients with poor-risk CLL receiving SHDT during the course of their disease.
authors.affiliation: Department of Hematology, Allgemeines Krenkenhaus St Georg, Hamburg, Germany. peter.dreger@ak-stgeorg.lbk-hh.de
authors.forename: Peter
authors.initials: P
authors.lastname: Dreger
authors.forename: Stephan
authors.initials: S
authors.lastname: Stilgenbauer
authors.forename: Axel
authors.initials: A
authors.lastname: Benner
authors.forename: Matthias
authors.initials: M
authors.lastname: Ritgen
authors.forename: Alexander
authors.initials: A
authors.lastname: Kröber
authors.forename: Michael
authors.initials: M
authors.lastname: Kneba
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.forename: Hartmut
authors.initials: H
authors.lastname: Döhner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002874:Chromosome Mapping; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017353:Gene Deletion; D005803:Genes, Immunoglobulin / Q000235:genetics*; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics*; D007135:Immunoglobulin Variable Region / Q000235:genetics*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000235:genetics* / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D033581:Stem Cell Transplantation; D013997:Time Factors; D014178:Translocation, Genetic; D014182:Transplantation, Autologous; D014314:Trisomy
chemical_list: D007143:Immunoglobulin Heavy Chains; D007135:Immunoglobulin Variable Region