title: Hematopoietic cell transplantation after nonmyeloablative conditioning for advanced chronic lymphocytic leukemia.
abstract: OBJECTIVE
  Patients with chemotherapy-refractory chronic lymphocytic leukemia (CLL) have a short life expectancy. The aim of this study was to analyze the outcome of patients with advanced CLL when treated with nonmyeloablative conditioning and hematopoietic cell transplantation (HCT).
  
  
  METHODS
  Sixty-four patients diagnosed with advanced CLL were treated with nonmyeloablative conditioning (2 Gy total-body irradiation with [n = 53] or without [n = 11] fludarabine) and HCT from related (n = 44) or unrelated (n = 20) donors. An adapted form of the Charlson comorbidity index was used to assess pretransplantation comorbidities.
  
  
  RESULTS
  Sixty-one of 64 patients had sustained engraftment, whereas three patients rejected their grafts. The incidences of grades 2, 3, and 4 acute and chronic graft-versus-host disease were 39%, 14%, 2%, and 50%, respectively. Three patients who underwent transplantation in complete remission (CR) remained in CR. The overall response rate among 61 patients with measurable disease was 67% (50% CR), whereas 5% had stable disease. All patients with morphologic CR who were tested by polymerase chain reaction (n = 11) achieved negative molecular results, and one of these patients subsequently experienced disease relapse. The 2-year incidence of relapse/progression was 26%, whereas the 2-year relapse and nonrelapse mortalities were 18% and 22%, respectively. Two-year rates of overall and disease-free survivals were 60% and 52%, respectively. Unrelated HCT resulted in higher CR and lower relapse rates than related HCT, suggesting more effective graft-versus-leukemia activity.
  
  
  CONCLUSIONS
  CLL is susceptible to graft-versus-leukemia effects, and allogeneic HCT after nonmyeloablative conditioning might prolong median survival for patients with advanced CLL.
authors.affiliation: Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, D1-100, PO Box 19024, Seattle, WA 98109-1024, USA.
authors.forename: Mohamed L
authors.initials: ML
authors.lastname: Sorror
authors.forename: Michael B
authors.initials: MB
authors.lastname: Maris
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: Barry E
authors.initials: BE
authors.lastname: Storer
authors.forename: Monic J
authors.initials: MJ
authors.lastname: Stuart
authors.forename: Ute
authors.initials: U
authors.lastname: Hegenbart
authors.forename: Edward
authors.initials: E
authors.lastname: Agura
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Chauncey
authors.forename: Jose
authors.initials: J
authors.lastname: Leis
authors.forename: Michael
authors.initials: M
authors.lastname: Pulsipher
authors.forename: Peter
authors.initials: P
authors.lastname: McSweeney
authors.forename: Jerald P
authors.initials: JP
authors.lastname: Radich
authors.forename: Christopher
authors.initials: C
authors.lastname: Bredeson
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Amelia
authors.initials: A
authors.lastname: Langston
authors.forename: Michael R
authors.initials: MR
authors.lastname: Loken
authors.forename: Haifa
authors.initials: H
authors.lastname: Al-Ali
authors.forename: Karl G
authors.initials: KG
authors.lastname: Blume
authors.forename: Rainer
authors.initials: R
authors.lastname: Storb
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D020544:Graft vs Leukemia Effect; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012074:Remission Induction; D016879:Salvage Therapy; D015996:Survival Rate; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014916:Whole-Body Irradiation
chemical_list: D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine