Autologous hematopoietic stem cell transplantation as salvage treatment for advanced B cell chronic lymphocytic leukemia

Abstract

Given the generally poor outcome of advanced B cell chronic lymphocytic leukemia, experimental approaches are warranted, especially for younger patients in whom classical treatments have failed. We therefore conducted a prospective singlecenter study, using polychemotherapy (ESHAP) to prepare patients for hematopoietic stem cell collection and autologous stem cell transplantation as consolidation therapy. Twenty patients entered the study. An adequate response to ESHAP was obtained in 13 patients, and sufficient stem cells for grafting were obtained in eight of the 12 patients who underwent the collection procedure. Six of these grafted patients are alive in complete clinical remission a median of 30 months after transplantation. It should be noted that we were only able to graft 40% of the patients enrolled in this study, either because a new remission could not be obtained or because not enough hematopoietic stem cells could be collected. This argues for stem cell collection as soon as a first remission is obtained, even if the autograft is done later in the course of the disease.

Autologous stem cell transplantation as a first-line treatment strategy for chronic lymphocytic leukemia: a multicenter, randomized, controlled trial from the SFGM-TC and GFLLC

“…11,12,14,15 MRD negativity and longterm CR have also been achieved with autologous stem cell transplantation (ASCT) after salvage chemotherapy, even in relapsing and resistant patients. [16][17][18] ASCT has also been prospectively Submitted November 21, 2010; accepted March 3, 2011. Prepublished online as Blood First Edition paper, March 15, 2011; DOI 10.1182 DOI 10.…”

“…11,12,14,15 MRD negativity and longterm CR have also been achieved with autologous stem cell transplantation (ASCT) after salvage chemotherapy, even in relapsing and resistant patients. [16][17][18] ASCT has also been prospectively evaluated, with promising results, as a first-line treatment for CLL, but only in nonrandomized, phase 2 studies. [19][20][21] In 2001, we launched a multicenter randomized, phase 3 trial involving patients Ͻ 66 years with stage B or C CLL.…”

Blood stem cell mobilization and collection in patients with chronic lymphocytic leukaemia: a nationwide analysis

“…Based on this survey as well as previous studies 8,11,12,14,15,[20][21][22] (Table 4), patients with CLL are more difficult to mobilize than many other haematological patient groups. Previous treatments have been variable, as have the mobilization regimens used preventing more detailed conclusions, but success rates for collections have been in the order of 60-70% in most studies.…”

Alkylating agents and nucleoside analogues in the treatment of B cell chronic lymphocytic leukemia

“…121,123 Unfortunately, the high relapse rate and the absence of a plateau in disease-free survival curves indicate that autologous SCT does not cure CLL. However, to determine the real role of this procedure in the management of CLL further investigation is necessary.…”