Allogeneic Hematopoietic Cell Transplant for Prolymphocytic Leukemia

Abstract

The poor prognosis of patients with prolymphocytic leukemia (PLL) has led some clinicians to recommend allogeneic hematopoietic cell transplant (HCT). However, the data to support this approach is limited to case-reports and small case-series. We reviewed the database of the Center for International Blood & Marrow Transplant Research to determine outcomes after allotransplant for patients with PLL. We identified 47 patients with a median age of 54 years (range, 30–75). With a median follow-up of 13 months, progression-free survival was 33% (95% Confidence Interval 20–47%) at 2 years. The most common cause of death was relapse or progression in 49%. The cumulative incidence of treatment-related mortality at 1-year post transplant was 28%. The small patient population prohibited prognostic factor analysis but these data support consideration of allotransplant for PLL. Further study of a larger population of patients is needed to determine which patients are more likely to benefit.

Hematopoietic stem cell transplantation in T-prolymphocytic leukemia: a retrospective study from the European Group for Blood and Marrow Transplantation and the Royal Marsden Consortium

“…One-year survival was 33%; however, the follow-up in this study was only 13 months, and survival times were not specifically reported for those 21 patients who indeed had T-PLL (the remainder had B-PLL or PLL unspecified). 15 The present study is the first investigating a larger number of allotransplantations for T-PLL with a reasonable follow-up. However, only one-fourth of the included patients were in CR at HSCT, whereas for other patients allo-HSCT apparently was used as rescue procedure and therefore, the preselection for patients with very poor prognosis has to be taken into consideration.…”

“…The median OS of all transplanted patients compared favorably with that of 23 control patients who achieved CR after alemtuzumab without subsequent HSCT and survived at least 6 months thereafter (48 vs 20 months). 14 A CIBMTR registry analysis 15 identified 47 patients with prolymphocytic leukemia who had undergone allogeneic HSCT. One-year survival was 33%; however, the follow-up in this study was only 13 months, and survival times were not specifically reported for those 21 patients who indeed had T-PLL (the remainder had B-PLL or PLL unspecified).…”

“…8 --13 More recently, small registry analyses suggested that long-term disease control can be observed after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in some patients with T-PLL. 14,15 Pooling together patients from the European Group for Blood and Marrow Transplantation (EBMT) database with those from the Royal Marsden series, the present retrospective study analyzes the largest sample of allo-HSCT in T-PLL available to date.…”

How I treat prolymphocytic leukemia

“…Allogeneic HSCT gives patients the possibility of a long-term cure by potentially harnessing a graftversus-leukemia effect. 29,75 However, the morbidity and mortality associated with this procedure are significant, and often it is not a feasible option because of patient age or comorbidities. However, the introduction of nonmyeloablative approaches has widened the eligibility, making this available as a treatment option in a larger cohort of patients.…”

“…Experience with both autologous and allogeneic HSCT, although limited, is encouraging. [26][27][28][29][30][31][32] Single case reports and small series are often misleading because of patient selection bias, and there are only 3 larger reports of hematopoietic stem cell transplantation (HSCT) in the literature. Nevertheless, our experience suggests that consolidation with an HSCT in first or subsequent remission offers potential advantages to patients.…”