title: Autologous and allogeneic stem cell transplantations for poor-risk chronic lymphocytic leukemia.
abstract: 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.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. john.gribben@cancer.org.uk
authors.forename: John G
authors.initials: JG
authors.lastname: Gribben
authors.forename: David
authors.initials: D
authors.lastname: Zahrieh
authors.forename: Katherine
authors.initials: K
authors.lastname: Stephans
authors.forename: Lini
authors.initials: L
authors.lastname: Bartlett-Pandite
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Alyea
authors.forename: David C
authors.initials: DC
authors.lastname: Fisher
authors.forename: Arnold S
authors.initials: AS
authors.lastname: Freedman
authors.forename: Peter
authors.initials: P
authors.lastname: Mauch
authors.forename: Robert
authors.initials: R
authors.lastname: Schlossman
authors.forename: Lecia V
authors.initials: LV
authors.lastname: Sequist
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: Blossom
authors.initials: B
authors.lastname: Marshall
authors.forename: Donna
authors.initials: D
authors.lastname: Neuberg
authors.forename: Jerome
authors.initials: J
authors.lastname: Ritz
authors.forename: Lee M
authors.initials: LM
authors.lastname: Nadler
mesh_terms: 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
chemical_list: D007143:Immunoglobulin Heavy Chains