Long-term outcome of allogeneic stem cell transplantation in chronic lymphocytic leukemia: analysis after a minimum follow-up of 5 years

Abstract

In order to evaluate the long-term results of allogeneic stem cell transplantation (ASCT) in B-cell chronic lymphocytic leukemia (CLL), we reviewed the outcome of 12 consecutive CLL patients, who underwent ASCT at the Mayo Clinic prior to July, 2004. Median age was 44 years (range 18-55) and median time from diagnosis to transplant 58.5 months. All patients had failed prior fludarabine-based chemotherapy and all but two patients had chemo-resistant refractory disease at time of transplant. A 'myeloablative' conditioning regimen was used in 11 patients and 'reduced intensity' in one. Bone marrow was the source of hematopoietic stem cells in 10 patients and peripheral blood in two. Donors were matched sibling in nine patients, unrelated in two and partial phenotypic match father in one. Grade II-IV acute and chronic graft versus host disease was documented in five and four patients, respectively. To date, six patients (50%) have died including four early deaths from infection. Complete remission (CR) was documented in eight patients (66.7%) post-transplant; six are currently alive whereas one died at 7 months from infection while still in CR and one relapsed 7 months post-transplant and died later. One CR patient relapsed after 4.5 years but was successfully re-transplanted and remains in second CR for 6.5+ years. Another patient recently relapsed after 10.5 years of CR. Duration of ASCT-induced CR in the remaining four patients was 6.5+, 8.5+, 9+ and 10+ years. All surviving patients displayed excellent performance status without ongoing chronic graft versus host disease. We conclude that ASCT is an effective salvage therapy for fludarabine-refractory CLL but late relapses can occur.

Outcomes of Human Leukocyte Antigen–Matched Sibling Donor Hematopoietic Cell Transplantation in Chronic Lymphocytic Leukemia: Myeloablative Versus Reduced-Intensity Conditioning Regimens

“…When assessing such subjects in this study, there was no difference in disease relapse/progression or survival between those undergoing MA and RIC HCT. This suggests that the unfavorable prognosis of fludarabine-refractory disease may be overcome by either MA or RIC approaches, as reported by others [15,28]. …”

Favorable Outcomes in Patients Surviving 5 or More Years after Allogeneic Hematopoietic Stem Cell Transplantation for Hematologic Malignancies

“…The incidence of acute and /or chronic GVHD was 30-70% in patients with hematologic diseases undergoing allogeneic SCT (33-35). The development of chronic GVHD appears to be important in reducing relapses after SCT (36).…”

Allogeneic hematopoietic cell transplantation for chronic lymphocytic leukemia: ready for prime time?

“…In this respect, there are plenty of reports in the literature of relapses up to 10 years after allo-HCT, and a significant percentage of these late relapses occurred in lymph nodes in the absence of bone marrow or peripheral blood involvement, or even in patients with MRD Ϫ status. 29,36,37,39,69,70 Furthermore, the presence of bulky lymphadenopathy at the time of allo-HCT had a negative impact on PFS in the FHCRC study, further sustaining the hypothesis of the existence of "GVCLL sanctuary sites." 43 It is thus apparent that, at least in a fraction of patients, the GVCLL effect is inadequate to ensure complete disease eradication.…”