Allogeneic stem cell transplantation and donor lymphocyte infusions for chronic myelomonocytic leukemia

Abstract

Prognosis in chronic myelomonocytic leukemia (CMML) is unfavorable and the optimal therapy remains uncertain. Currently, allogeneic stem cell transplantation is the only known curative therapeutic option. However, the data available are limited and restricted to small retrospective series. There is even less information on the use of donor lymphocyte infusions (DLI) for this disease. We reviewed our experience of allogeneic stem cell transplantation and DLI for adults with CMML. Seventeen consecutive adults underwent allogeneic stem cell transplantation from related (n ¼ 14) or unrelated (n ¼ 3) donors. Median age was 50 years (range 26-60). Seven patients (41%) demonstrated relapse or persistent disease at a median of 6 months (range 3-55.5). Five patients underwent DLI for morphologic relapse and one for mixed donor chimerism. Two patients achieved durable complete remissions of 15 months each. The overall transplantrelated mortality was 41% (n ¼ 7). With a median followup of 34.5 months, three patients (18%) currently remain alive and in continuous CR. The current study demonstrates a graft-versus-leukemia effect in CMML, both for allogeneic stem cell transplantation and for DLI. Nevertheless, consistent with reported experience of others, overall outcomes remain less than optimal and unpredictable.

Current status of allogeneic HST for chronic myelomonocytic leukemia

“…32,34 Two studies included patients with CMML transforming to AML. 26,29 The largest multicenter study comprising 50 adult patients with CMML was led by Kroger et al 31 on behalf of European Group for Blood and Marrow Transplant.…”

“…Characteristics of the studies/patients are summarized in Table 1. 26,28,29,31,32,34,36,40 All studies that fulfilled the inclusion criteria were retrospective studies, with six out of eight (71%) being single institution experiences. Two studies included patients with MDS or MPD, and provided details describing the outcome of adult CMML patients.…”

“…In particular, the more recently published four studies reported transplantations mostly between 1998 and 2008, 29,32,36,40 whereas the four earlier studies included transplantations between 1988 and 2004. 26,29,31,34 Disease burden at transplant. In all, 100 patients had BM blasts p5%, whereas 56 patients had BM blasts 45% at the time of transplantation.…”

“…In all, 18 references were selected for full-text analysis. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Two studies were exempt from the age limit inclusion criterion owing to their relative large size and the detailed analysis that was provided by the authors. Kerbauy et al 28 reported on the transplant outcomes of 43 CMML patients age 1-66 years and, more recently, Eissa et al 41 included this same cohort in an updated study of 85 patients with CMML who underwent HST at the Fred Hutchinson Cancer and Research Center.…”

Chronic myelomonocytic leukemia “myelodysplastic type’’ in transformation to acute myeloid leukemia – diagnostic and therapeutic options: case report and literature review / Leucemie mielomonocitară cronică forma mielodisplazică în transformare spre leucemie acută mieloidă – diagnostic și opțiuni terapeutice: prezentare de caz și revizuirea literaturii

“…Data for Allo-HSCT results in CMML can be found in the reports on allo-HSCT in MDS and MPN or in retrospective studies on small number of CMML transplanted patients. There are no randomized prospective (Table 2) [20][21][22][23][24][25][26][27][28][29][30][31]. In 2015 two reports ''specifically'' focused on the evolution of allo-HCST in CMML appeared.…”