title: Does total body irradiation conditioning improve outcomes of myeloablative human leukocyte antigen-identical sibling transplantations for chronic lymphocytic leukemia?
abstract: An allogeneic hematopoietic cell transplantation from an HLA-identical donor after high-dose (myeloablative) pretransplantation conditioning is an effective therapy for some people with chronic lymphocytic leukemia (CLL). Because CLL is a highly radiosensitive cancer, we hypothesized that total body irradiation (TBI) conditioning regimens may be associated with better outcomes than those without TBI. To answer this, we analyzed data from 180 subjects with CLL receiving myeloablative doses of TBI (n = 126) or not (n = 54), who received transplants from an HLA-identical sibling donor between 1995 and 2007 and reported to the Center for International Blood & Marrow Transplant Research. At 5 years, treatment-related mortality was 48% (95% confidence interval [CI], 39% to 57%) versus 50% (95% CI, 36% to 64%); P = NS. Relapse rates were 17% (95% CI, 11% to 25%) versus 22% (95% CI, 11% to 35%); P = NS. Five-year progression-free survival and overall survival were 34% (95% CI, 26% to 43%) versus 28% (95% CI, 15% to 42%); P = NS and 42% (95% CI, 33% to 51%) versus 33% (95% CI, 19% to 48%); P = NS, respectively. The single most common cause of death in both cohorts was recurrent/progressive CLL. No variable tested in the multivariate analysis was found to significantly affect these outcomes, including having failed fludarabine. Within the limitations of this study, we found no difference in HLA-identical sibling transplantation outcomes between myeloablative TBI and chemotherapy pretransplantation conditioning in persons with CLL.
authors: Division of Hematology, Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: msabloff@ottawahospital.on.ca.
authors: Mitchell
authors: M
authors: Sabloff
authors: Division of Hematologic Oncology and Blood Disorders, Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Ronald M
authors: RM
authors: Sobecks
authors: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Kwang Woo
authors: KW
authors: Ahn
authors: Center for International Blood & Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Xiaochun
authors: X
authors: Zhu
authors: Division of Hematologic Malignancies and Stem Cell Transplantation, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
authors: Marcos
authors: M
authors: de Lima
authors: Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts.
authors: Jennifer R
authors: JR
authors: Brown
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Yoshihiro
authors: Y
authors: Inamoto
authors: Division of Oncology and Hematology, The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
authors: H Kent
authors: HK
authors: Holland
authors: Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
authors: Mahmoud D
authors: MD
authors: Aljurf
authors: Hematopoietic Cell Transplantation Program, University Hospitals Case Medical Center, University of Virginia Health System, Charlottesville, Virginia.
authors: Mary J
authors: MJ
authors: Laughlin
authors: Division of Hematology and Oncology, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas.
authors: Rammurti T
authors: RT
authors: Kamble
authors: Division of Hematology and Oncology, Department of Medicine, Shands Healthcare & University of Florida, Gainesville, Florida.
authors: Jack W
authors: JW
authors: Hsu
authors: Division of Hematology and Oncology, Stony Brook University Medical Center, Stony Brook, New York.
authors: Baldeep M
authors: BM
authors: Wirk
authors: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors: Matthew
authors: M
authors: Seftel
authors: Haematology and Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors: Ian D
authors: ID
authors: Lewis
authors: Division of Hematology, Oncology and Transplant, University of Minnesota Medical Center, Fairview, Minneapolis, Minneapolis.
authors: Mukta
authors: M
authors: Arora
authors: Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts.
authors: Edwin P
authors: EP
authors: Alyea
authors: Division of Hematologic Oncology and Blood Disorders, Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Matt E
authors: ME
authors: Kalaycio
authors: Department of Leukemia, MD Anderson Cancer Center, Houston, Texas.
authors: Jorge
authors: J
authors: Cortes
authors: Center for Hematologic Malignancies, OHSU Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
authors: Richard T
authors: RT
authors: Maziarz
authors: Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, United Kingdom.
authors: Robert Peter
authors: RP
authors: Gale
authors: Center for International Blood & Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Wael
authors: W
authors: Saber
mesh_terms: D000328:Adult; D005260:Female; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D012008:Recurrence; D035781:Siblings; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014185:Transplantation, Isogeneic; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014916:Whole-Body Irradiation
chemical_list: D006680:HLA Antigens; D019653:Myeloablative Agonists; D014740:Vidarabine; C024352:fludarabine
keywords: Chronic lymphocytic leukemia; Conditioning; Myeloablative; Total body irradiation