title: Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease.
abstract: In all, 30 patients with CLL proceeded to myeloablative allogeneic BMT using related (n=20, 67%) or unrelated (n=10) donors, at the Princess Margaret Hospital (Toronto) (n=20) or the Leukemia/BMT Program of BC (Vancouver) (n=10), from 1989 to 2001. Median (range) interval from diagnosis to BMT was 4.8 (0.3-13) years, median number of prior therapies was three and median age 48 years. The preparative regimen included total body irradiation in 15 (50%). In all, 14 of 30 patients (47%) are alive, with median (range) follow up of 4.3 (2.4-10.5) years. All are in complete remission, two following therapy for post-BMT progression. Actuarial overall (OS) and event-free survival (EFS) at 5 years is 39% (OS 48% for related donor and 20% for unrelated donor BMT); cumulative incidence of nonrelapse mortality (NRM) and relapse is 47 and 19%, respectively. Both acute (RR=0.008, P=0.01) and chronic (RR=0.006, P=0.02) Graft-versus-host disease (GVHD) were associated with markedly decreased risk of relapse. Patients receiving grafts from unrelated donors had increased NRM (RR=3.6, P=0.02) and decreased OS (RR of death=3.4, P=0.002). Allogeneic BMT has resulted in long-term EFS in approximately 40% of patients with CLL. There is evidence for a strong graft-versus-leukemia effect associated with acute and chronic GVHD, resulting in near complete protection from relapse.
authors.affiliation: Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver Hospital & Health Sciences Centre, BC Cancer Agency and University of BC, Vancouver, British Columbia, Canada. ctoze@bccancer.bc.ca
authors.forename: C L
authors.initials: CL
authors.lastname: Toze
authors.forename: A
authors.initials: A
authors.lastname: Galal
authors.forename: M J
authors.initials: MJ
authors.lastname: Barnett
authors.forename: J D
authors.initials: JD
authors.lastname: Shepherd
authors.forename: E A
authors.initials: EA
authors.lastname: Conneally
authors.forename: D E
authors.initials: DE
authors.lastname: Hogge
authors.forename: S H
authors.initials: SH
authors.lastname: Nantel
authors.forename: T J
authors.initials: TJ
authors.lastname: Nevill
authors.forename: H J
authors.initials: HJ
authors.lastname: Sutherland
authors.forename: J M
authors.initials: JM
authors.lastname: Connors
authors.forename: N J
authors.initials: NJ
authors.lastname: Voss
authors.forename: T L
authors.initials: TL
authors.lastname: Kiss
authors.forename: H A
authors.initials: HA
authors.lastname: Messner
authors.forename: J C
authors.initials: JC
authors.lastname: Lavoie
authors.forename: D L
authors.initials: DL
authors.lastname: Forrest
authors.forename: K W
authors.initials: KW
authors.lastname: Song
authors.forename: C A
authors.initials: CA
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Lipton
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality*; D020544:Graft vs Leukemia Effect / Q000528:radiation effects; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation / Q000379:methods