Richter's syndrome after allogeneic stem cell transplantation for chronic lymphocytic leukaemia successfully treated by withdrawal of immunosuppression, and donor lymphocyte infusion

Español, Ignacio; Büchler, Tomáš; Ferrà, Christelle; Gallardo, David; Reyes, Pedro; Sarrà, Josep; Domingo, A; Romagosa, V.; Grañena, A

doi:10.1038/sj.bmt.1703788

Cited by 20 publications

(7 citation statements)

References 14 publications

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“…14,[33][34][35][36][37][38][39][40] The positive impact of GVHD/GVL on relapse post allograft for CLL is convincingly demonstrated in this analysis. The principle of the antitumor effect of GVH/GVL is employed in the strategy of nonmyeloablative allografting.…”

Section: Discussionmentioning

confidence: 49%

“…Multiple series have reported promising early results using this strategy for CLL. 15,[37][38][39][40][41][42][43][44][45][46][47][48][49] Safety and feasibility have been demonstrated, along with some evidence of disease control. Although regimen-related toxicity is lower in nonmyeloablative as compared with myeloablative allografting, 15,38 rates of GVHD do not appear dissimilar.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease

Toze

Galal

Barnett

et al. 2005

Bone Marrow Transplant

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Summary:In all, 30 patients with CLL proceeded to myeloablative allogeneic BMT using related (n ¼ 20, 67%) or unrelated (n ¼ 10) donors, at the Princess Margaret Hospital (Toronto) (n ¼ 20) or the Leukemia/BMT Program of BC (Vancouver) (n ¼ 10), from 1989 to 2001. Median (range) interval from diagnosis to BMT was 4.8 (0.3-13) years, median number of prior therapies was three and median age 48 years. The preparative regimen included total body irradiation in 15 (50%). In all, 14 of 30 patients (47%) are alive, with median (range) follow up of 4.3 (2.4-10.5) years. All are in complete remission, two following therapy for post-BMT progression. Actuarial overall (OS) and event-free survival (EFS) at 5 years is 39% (OS 48% for related donor and 20% for unrelated donor BMT); cumulative incidence of nonrelapse mortality (NRM) and relapse is 47 and 19%, respectively. Both acute (RR ¼ 0.008, P ¼ 0.01) and chronic (RR ¼ 0.006, P ¼ 0.02) Graft-versus-host disease (GVHD) were associated with markedly decreased risk of relapse. Patients receiving grafts from unrelated donors had increased NRM (RR ¼ 3.6, P ¼ 0.02) and decreased OS (RR of death ¼ 3.4, P ¼ 0.002). Allogeneic BMT has resulted in long-term EFS in approximately 40% of patients with CLL. There is evidence for a strong graft-versus-leukemia effect associated with acute and chronic GVHD, resulting in near complete protection from relapse. Bone Marrow Transplantation (2005) 36, 825-830.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease

Toze

Galal

Barnett

et al. 2005

Bone Marrow Transplant

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“…Similar to the previous studies, a higher median total cell dose infused (410 Â 10 6 CD3/kg) and development of GVHD improved response. The 2-year OS for the entire cohort was 55% (95% CI: [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. A retrospective analysis by Shaw et al 11 reported on the outcomes of DLI in patients who received TCD with Campath as part of RIC conditioning.…”

Section: Tdli Vs Pdlimentioning

confidence: 99%

“…[52][53][54][55] Two larger series limited to NHL have been published. 52,55 Russell et al 52 reported 17 patients who received DLI after allogeneic HCT (related donor ¼ 15; URD ¼ 2) between 1996 and 2005 for either disease relapse (n ¼ 10) or refractory disease (n ¼ 7).…”

Section: Nhlmentioning

confidence: 99%

Donor lymphocyte infusions: the long and winding road: how should it be traveled?

Tomblyn

Lazarus

2008

Bone Marrow Transplant

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Donor lymphocyte infusions (DLI) often are used after allo-SCT to augment the graft-versus-tumor effect. Timing of infusion varies according to indication, for example to treat tumor recurrence, as a planned strategy to prevent disease relapse in the setting of T-cell-depleted grafts or non-myeloablative conditioning regimens, or as a method to convert mixed to full donor chimerism. The optimal strategy of timing, use of cytotoxic conditioning, cell dose and cell product composition, and so on, for DLI administration remains unclear. Despite varied techniques, DLI may lead to 3-year disease-free survivals (DFS) in excess of 60% for all CML patients and approach 90% in patients with only molecular or cytogenetic relapse. Other hematologic malignancies appear much less responsive, as less than 50% of patients respond and provide, at best, 3-year DFS rates of 20-50%. Multiple myeloma patients have overall response rates of 40-45% after DLI, suggesting benefit in relapsed disease, but limited experiences for diseases such as Hodgkin's lymphoma, myelodysplasia and ALL preclude recommendations for use of DLI at this time. Regardless of the indication, treatment-related mortality after DLI is 5-20% and more than one-third of patients will develop acute and/or chronic GVHD after DLI. The risks of these complications appear related, in part, to donor source, cell dose and therapy prior to DLI. Although there are no definitive answers, the information gleaned from published literature suggests that DLI should be administered early after relapse or as a prophylactic strategy in patients receiving T-cell-depleted grafts, and patients with bulky or aggressive disease may benefit from disease reduction prior to DLI.

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“…Its occurrence following allogeneic hematopoietic stem cell transplant (alloHCT) is extremely rare, with only one patient having been reported to date [2]. This patient was treated successfully with withdrawal of immunosuppressive drugs and donor lymphocyte infusion (DLI).…”

mentioning

confidence: 99%

Transformed large B-cell lymphoma in rituximab-allergic patient with chronic lymphocytic leukemia after allogeneic stem cell transplant: successful treatment with ofatumumab

Linden¹,

Bachanová²,

Sachs³

et al. 2012

Leukemia & Lymphoma

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Richter's syndrome after allogeneic stem cell transplantation for chronic lymphocytic leukaemia successfully treated by withdrawal of immunosuppression, and donor lymphocyte infusion

Cited by 20 publications

References 14 publications

Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease

Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease

Donor lymphocyte infusions: the long and winding road: how should it be traveled?

Transformed large B-cell lymphoma in rituximab-allergic patient with chronic lymphocytic leukemia after allogeneic stem cell transplant: successful treatment with ofatumumab

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