title: High-dose therapy and autologous hematopoietic cell transplantation as front-line consolidation in chronic lymphocytic leukemia: a systematic review.
abstract: High-dose therapy (HDT) followed by autologous hematopoietic cell transplantation (auto-HCT) is offered to patients with chronic lymphocytic leukemia (CLL) both as front-line consolidation and in the relapsed setting. The role of HDT in the front-line consolidation setting in CLL is uncertain. Literature search of PUBMED and Cochrane until 14 November 2014 and the last 2 years of abstracts from relevant conferences was undertaken. End points included benefits (overall survival; OS, PFS, event-free survival; EFS) and harms (adverse events, secondary malignancies, treatment-related mortality). The search identified 495 references of which four studies met inclusion criteria. Altogether, 301 patients were randomized to the HDT/auto-HCT arm and 299 patients to the control arm. Offering front-line HDT/auto-HCT did not result in statistically significant improvement in OS (Hazard ratio (HR)=0.91; 95% confidence interval (CI)= 0.62, 1.33) or PFS (HR=0.70; 95% CI= 0.32, 1.52). There was a statistically significant advantage favoring HDT/auto-HCT for EFS (HR=0.46; 95% CI= 0.26, 0.83). Moreover, HDT/auto-HCT did not result in higher rate of secondary malignancy (risk ratio=1.06; 95% CI=0.55, 2.05) or treatment-related mortality (risk ratio=1.32; 95% CI= 0.43, 4.06). Offering HDT/auto-HCT as front-line consolidation in patients with CLL does not improve OS. At present this approach should not be offered outside the context of a clinical trial.
authors: Center for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors: T
authors: T
authors: Reljic
authors: 1] Center for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, FL, USA [2] Department of Oncologic Sciences, H. Lee Moffitt Cancer Center/University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
authors: A
authors: A
authors: Kumar
authors: 1] Center for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, FL, USA [2] Department of Oncologic Sciences, H. Lee Moffitt Cancer Center/University of South Florida, Morsani College of Medicine, Tampa, FL, USA [3] Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
authors: B
authors: B
authors: Djulbegovic
authors: 1] Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA [2] Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
authors: M A
authors: MA
authors: Kharfan-Dabaja
mesh_terms: D064592:Autografts; D060830:Consolidation Chemotherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000401:mortality / Q000628:therapy*; D008297:Male; D039781:PubMed; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate