title: Outcomes of Patients With Chronic Lymphocytic Leukemia and Richter's Transformation After Transplantation Failure.
abstract: OBJECTIVE
  Allogeneic stem-cell transplantation (SCT) induces long-term remission in a fraction of patients with high-risk chronic lymphocytic leukemia (CLL) or Richter's transformation (RT). Our purpose was to determine the outcomes of patients whose disease progressed after allogeneic SCT.
  
  
  METHODS
  We retrospectively analyzed the outcomes of 72 patients (52 with CLL and 20 with RT) who underwent allogeneic SCT between 1998 and 2011 and had documented progression after transplantation. Twenty-two (31%) never had a response, and 50 (69%) had a response but experienced relapse after a median of 7 months (range, 2 to 85 months). Forty-eight patients who were receiving or were candidates to receive post-SCT cell-based therapies were not included in this analysis.
  
  
  RESULTS
  The median age at time of transplantation was 58 years (range, 30 to 72 years). Sixty-two patients (86%) received more than two treatment regimens and 37 (51%) received more than three treatment regimens before SCT. Sixty-six patients (92%) had active disease at the time of transplantation. The 2- and 5-year survival rates were 67% and 38% (patients with CLL) and 36% and 0% (patients with RT). The patients who developed acute or chronic graft-versus-host disease had a longer overall survival (OS; P = .05). In a multivariable analysis, RT or low hemoglobin at the time of SCT predicted shorter OS. Chronic graft-versus-host disease and an initial response to SCT predicted longer OS.
  
  
  CONCLUSIONS
  Patients with CLL in whom allogeneic SCT fails may have a response to and benefit from salvage therapies, and their prognosis is relatively good.
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Uri
authors.initials: U
authors.lastname: Rozovski
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ohad
authors.initials: O
authors.lastname: Benjamini
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Preetesh
authors.initials: P
authors.lastname: Jain
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Thompson
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: William G
authors.initials: WG
authors.lastname: Wierda
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Susan
authors.initials: S
authors.lastname: O'Brien
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Burger
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrajoli
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Stefan
authors.initials: S
authors.lastname: Faderl
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shpall
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Issa F
authors.initials: IF
authors.lastname: Khouri
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Keating
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX. zestrov@mdanderson.org.
authors.forename: Zeev
authors.initials: Z
authors.lastname: Estrov
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D018450:Disease Progression; D005163:Factor Analysis, Statistical; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010880:Piperidines; D011720:Pyrazoles / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods; D033581:Stem Cell Transplantation; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010880:Piperidines; D011720:Pyrazoles; D011743:Pyrimidines; C551803:ibrutinib; D000225:Adenine
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