title: Efficacy of cisplatin-based immunochemotherapy plus alloSCT in high-risk chronic lymphocytic leukemia: final results of a prospective multicenter phase 2 HOVON study.
abstract: Allogeneic stem cell transplantation (alloSCT) remains the only curative option for CLL patients. Whereas active disease at the time of alloSCT predicts poor outcome, no standard remission-induction regimen exists. We prospectively assessed outcome after cisplatin-containing immune-chemotherapy (R-DHAP) followed by alloSCT in 46 patients (median age 58 years) fulfilling modified European Society for Blood and Marrow Transplantation (EBMT) CLL Transplant Consensus criteria being refractory to or relapsed (R/R) <1 year after fludarabine or <2 years after fludarabine-based immunochemotherapy or R/R with del(17p). Twenty-nine patients received ⩾3 cycles of R-DHAP and sixteen <3 cycles (4 because of disease progression, 8 for toxicity and 4 toxic deaths). Overall rate of response to R-DHAP was 58%, 31 (67%) proceeded to alloSCT after conditioning with fludarabine and 2 Gy TBI. Twenty (65%) remained free from progression at 2 years after alloSCT, including 17 without minimal residual disease. Intention-to-treat 2-year PFS and overall survival of the 46 patients were 42 and 51% (35.5 months median follow-up); del(17p) or fludarabine refractoriness had no impact. R-DHAP followed by alloSCT is a reasonable treatment to be considered for high-risk CLL patients without access or resistance to targeted therapies.
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Gelder
authors.affiliation: Department of Hematology and Lymphoma and Myeloma Center, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M H
authors.initials: MH
authors.lastname: van Oers
authors.affiliation: HOVON Data Center, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: W G
authors.initials: WG
authors.lastname: Alemayehu
authors.affiliation: Department of Hematology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: M C J
authors.initials: MC
authors.lastname: Abrahamse-Testroote
authors.affiliation: Department of Hematology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Cornelissen
authors.affiliation: Department of Hematology, Free University Medical Center, Amsterdam, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: Chamuleau
authors.affiliation: Department of Hematology, Ziekenhuis Netwerk Antwerpen Stuivenberg, Antwerpen, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Zachée
authors.affiliation: Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hoogendoorn
authors.affiliation: Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Nijland
authors.affiliation: Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Petersen
authors.affiliation: Department of Internal Medicine, Spaarne Ziekenhuis, Hoofddorp, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Beeker
authors.affiliation: Department of Internal Medicine, Ziekenhuis Amstelland, Amstelveen, The Netherlands.
authors.forename: G-J
authors.initials: GJ
authors.lastname: Timmers
authors.affiliation: Department of Internal Medicine, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Verdonck
authors.affiliation: Department of Internal Medicine, Medisch Centrum Alkmaar, Alkmaar, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Westerman
authors.affiliation: Department of Internal Medicine, Antonius ziekenhuis Nieuwegein, Nieuwegein, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: de Weerdt
authors.affiliation: Department of Hematology and Lymphoma and Myeloma Center, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: Kater
mesh_terms: D002945:Cisplatin / Q000008:administration & dosage*; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D018365:Neoplasm, Residual; D012306:Risk; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin