Allogeneic haematopoietic stem cell transplantation for chronic lymphocytic leukaemia: outcome in a 20-year cohort.
The curative potential of allogeneic haematopoietic stem cell transplant (allo HSCT) in chronic lymphocytic leukaemia CLL is established, with a demonstrated role for graft-versus-leukaemia and less certainty for other factors in determining outcome. The first two decades of CLL patients proceeding to allo HSCT at the Leukaemia/Bone Marrow Transplant Program of British Columbia (n = 49 consecutive, 1991-2009) were studied to clarify factors predicting outcome. The donor was related in 29 (59%) and unrelated in 20 (41%). Conditioning was reduced-intensity in 27 (55%) and myeloablative in 22 (45%). Thirty-one of 49 patients survive with median follow-up of 5 years (0·2-15). Cumulative incidence of non-relapse mortality; complete remission (CR); clearance of fluorescence in situ hybridization (FISH) abnormality and progression at 10 years was 36%; 69%; 55% and 22%. Overall survival (OS) was 63% at 2 years; 55% at 5 years and beyond. Factors predicting OS (P value by log rank <0·05) were: comorbidity index <3, FISH rank (Dohner) and 17p deletion, alemtuzumab pre-HSCT, achievement of CR post-HSCT, donor chimerism >90%, clearance of FISH abnormality post-HSCT and absence of high-grade (3-4) graft-versus-host disease. Results from this province-wide, two-decade cohort demonstrated that a substantial proportion of patients with high-risk CLL become long term disease-free survivors.
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Cynthia L
CL
Toze
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Chinmay B
CB
Dalal
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Thomas J
TJ
Nevill
Cytogenetics Laboratory, Department of Pathology and Laboratory Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, BC.
Tanya L
TL
Gillan
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Yasser R
YR
Abou Mourad
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Michael J
MJ
Barnett
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Raewyn C
RC
Broady
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Donna L
DL
Forrest
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Donna E
DE
Hogge
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Stephen H
SH
Nantel
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Maryse M
MM
Power
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Kevin W
KW
Song
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Heather J
HJ
Sutherland
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Clayton A
CA
Smith
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
Sujaatha
S
Narayanan
Cancer Genetics Laboratory, Department of Pathology and Laboratory Medicine, BC Cancer Agency and University of British Columbia, Vancouver, BC.
Sean S
SS
Young
Division of Medical Oncology, BC Cancer Agency, Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada.
Joseph M
JM
Connors
Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver General Hospital, BC Cancer Agency, University of British Columbia, Vancouver, BC.
John D
JD
Shepherd
D000328:Adult; D000368:Aged; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome