title: Results of alemtuzumab-based reduced-intensity allogeneic transplantation for chronic lymphocytic leukemia: a British Society of Blood and Marrow Transplantation Study.
abstract: We report results in 41 consecutive patients with chronic lymphocytic leukemia (CLL) who underwent allogeneic hematopoietic cell transplantation (HCT) after fludarabine, melphalan, and alemtuzumab conditioning. Donors were 24 HLA-matched siblings and 17 unrelated volunteers, 4 of them mismatched with recipients. All but 3 patients had initial hematologic recovery, but 5 more patients had secondary graft failure. Median intervals to neutrophil (greater than 0.5 x 10(9)/L) and platelet (greater than 20 x 10(9)/L) recovery were 14 days (range, 9-30 days) and 11 days (range, 8-45 days), respectively. Eleven (27%) patients had relapses and received escalated donor lymphocyte infusions, but only 3 of them had sustained responses. Acute and chronic graft-versus-host disease (GVHD) was observed in 17 (41%) and 13 (33%) patients, respectively. Seventeen (41%) patients have died, 5 of progressive disease. The 2-year overall survival and transplantation-related mortality (TRM) rates were 51% (95% confidence interval [CI], 33%-69%) and 26% (95% CI, 14%-46%), respectively. The alemtuzumabbased regimen was feasible and effective in patients with CLL with a relatively low rate of GVHD. However, TRM remains relatively high as a result of a variety of viral and fungal infections. Studies are ongoing to address the efficacy of reduced doses of alemtuzumab in this group of immunosuppressed patients.
authors.affiliation: Department of Hematology, Birmingham Heartlands Hospital, Birmingham, B9 5SS, United Kingdom.
authors.forename: Julio
authors.initials: J
authors.lastname: Delgado
authors.forename: Kirsty
authors.initials: K
authors.lastname: Thomson
authors.forename: Nigel
authors.initials: N
authors.lastname: Russell
authors.forename: Joanne
authors.initials: J
authors.lastname: Ewing
authors.forename: Wendy
authors.initials: W
authors.lastname: Stewart
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
authors.forename: Stephen
authors.initials: S
authors.lastname: Devereux
authors.forename: Richard
authors.initials: R
authors.lastname: Lovell
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chopra
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Stephen
authors.initials: S
authors.lastname: Mackinnon
authors.forename: Donald W
authors.initials: DW
authors.lastname: Milligan
mesh_terms: D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control; D006650:Histocompatibility Testing; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors; D018183:Transplantation Chimera; D014184:Transplantation, Homologous / Q000276:immunology; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000970:Antineoplastic Agents; D000074323:Alemtuzumab