Autologous and allogeneic stem cell transplantations for poor-risk chronic lymphocytic leukemia.
We report here on the long-term follow-up on 162 patients with high-risk chronic lymphocytic leukemia (CLL) who have undergone hematopoietic stem cell transplantation (SCT) at a single center from 1989 to 1999. Twenty-five patients with human leukocyte antigen (HLA)-matched sibling donors underwent T-cell-depleted allogeneic SCT, and 137 patients without HLA-matched sibling donors underwent autologous SCT. The 100-day mortality was 4% for both groups, but later morbidity and mortality were negatively affected on outcome. Progression-free survival was significantly longer following autologous than allogeneic SCT, but there was no difference in overall survival and no difference in the cumulative incidence of disease recurrence or deaths without recurrence between the 2 groups. At a median follow-up of 6.5 years there is no evidence of a plateau of progression-free survival. The majority of patients treated with donor lymphocyte infusions after relapse responded, demonstrating a significant graft-versus-leukemia effect in CLL. From these findings we have altered our approach for patients with high-risk CLL and are currently exploring the role of related and unrelated allogeneic SCT following reduced-intensity conditioning regimens.
Gribben
John G
JG
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. john.gribben@cancer.org.uk
Zahrieh
David
D
Stephans
Katherine
K
Bartlett-Pandite
Lini
L
Alyea
Edwin P
EP
Fisher
David C
DC
Freedman
Arnold S
AS
Mauch
Peter
P
Schlossman
Robert
R
Sequist
Lecia V
LV
Soiffer
Robert J
RJ
Marshall
Blossom
B
Neuberg
Donna
D
Ritz
Jerome
J
Nadler
Lee M
LM
D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D007143:Immunoglobulin Heavy Chains