Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning.
OBJECTIVE
We reported encouraging early results of allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning in 64 patients who had advanced chronic lymphocytic leukemia (CLL). Here, we have extended the follow-up to a median of 5 years and have included data on an additional 18 patients.


METHODS
Eighty-two patients, age 42 to 72 years, who had fludarabine-refractory CLL were conditioned with 2 Gy total-body irradiation alone or combined with fludarabine followed by HCT from related (n = 52) or unrelated (n = 30) donors.


RESULTS
Complete remission (CR) and partial remission were achieved in 55% and 15% of patients, respectively. Higher CR rates were noted after unrelated HCT (67% v 48%). The 5-year incidences of nonrelapse mortality (NRM), progression/relapse, overall survival, and progression-free survival were 23%, 38%, 50%, and 39%, respectively. Among 25 patients initially reported in CR, 8% relapsed and 8% died as a result of NRM, whereas 84% have remained alive and in CR. Among 14 responding patients who were tested and who had molecular eradication of their disease, two died as a result of NRM, two relapsed, and 10 have remained negative. At 5 years, 76% of living patients were entirely well, whereas 24% continued to receive immunosuppression for chronic graft-versus-host disease; the median performance status in each group was 100% and 90%, respectively. Lymphadenopathy > or = 5 cm, but not cytogenetic abnormalities at HCT, predicted relapse. In a risk-stratification model, patients who had lymphadenopathy less than 5 cm and no comorbidities had a 5-year OS of 71%.


CONCLUSIONS
Nonmyeloablative HCT resulted in a median survival of 5 years for patients who had fludarabine-refractory CLL with sustained remissions and in the continued resolution of chronic graft-versus-host disease in surviving patients.
Sorror
Mohamed L
ML
Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. msorror@fhcrc.org
Storer
Barry E
BE
Sandmaier
Brenda M
BM
Maris
Michael
M
Shizuru
Judith
J
Maziarz
Richard
R
Agura
Edward
E
Chauncey
Thomas R
TR
Pulsipher
Michael A
MA
McSweeney
Peter A
PA
Wade
James C
JC
Bruno
Benedetto
B
Langston
Amelia
A
Radich
Jerald
J
Niederwieser
Dietger
D
Blume
Karl G
KG
Storb
Rainer
R
Maloney
David G
DG
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012074:Remission Induction; D018570:Risk Assessment; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
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