Allogeneic haematopoietic stem cell transplantation for chronic lymphocytic leukaemia: outcome in a 20-year cohort.

Abstract

The curative potential of allogeneic haematopoietic stem cell transplant (allo HSCT) in chronic lymphocytic leukaemia CLL is established, with a demonstrated role for graft-versus-leukaemia and less certainty for other factors in determining outcome. The first two decades of CLL patients proceeding to allo HSCT at the Leukaemia/Bone Marrow Transplant Program of British Columbia (n = 49 consecutive, 1991-2009) were studied to clarify factors predicting outcome. The donor was related in 29 (59%) and unrelated in 20 (41%). Conditioning was reduced-intensity in 27 (55%) and myeloablative in 22 (45%). Thirty-one of 49 patients survive with median follow-up of 5 years (0·2-15). Cumulative incidence of non-relapse mortality; complete remission (CR); clearance of fluorescence in situ hybridization (FISH) abnormality and progression at 10 years was 36%; 69%; 55% and 22%. Overall survival (OS) was 63% at 2 years; 55% at 5 years and beyond. Factors predicting OS (P value by log rank <0·05) were: comorbidity index <3, FISH rank (Dohner) and 17p deletion, alemtuzumab pre-HSCT, achievement of CR post-HSCT, donor chimerism >90%, clearance of FISH abnormality post-HSCT and absence of high-grade (3-4) graft-versus-host disease. Results from this province-wide, two-decade cohort demonstrated that a substantial proportion of patients with high-risk CLL become long term disease-free survivors.

• Authors: Cynthia L Toze, Chinmay B Dalal, Thomas J Nevill, Tanya L Gillan, Yasser R Abou Mourad, Michael J Barnett, Raewyn C Broady, Donna L Forrest, Donna E Hogge, Stephen H Nantel, Maryse M Power, Kevin W Song, Heather J Sutherland, Clayton A Smith, Sujaatha Narayanan, Sean S Young, Joseph M Connors, John D Shepherd
• Journal: British journal of haematology (Br J Haematol) Vol. 158 Issue 2 Pg. 174-185 (Jul 2012) ISSN: 1365-2141 [Electronic] England
• PMID: 22640008 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2012 Blackwell Publishing Ltd.

Topics

• Adult
• Aged
• British Columbia (epidemiology)
• Cohort Studies
• Comorbidity
• Disease Progression
• Female
• Graft Survival
• Graft vs Host Disease (etiology)
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• In Situ Hybridization, Fluorescence
• Kaplan-Meier Estimate
• Leukemia, Lymphocytic, Chronic, B-Cell (mortality, therapy)
• Male
• Middle Aged
• Prognosis
• Remission Induction
• Transplantation Chimera
• Transplantation Conditioning (methods)
• Treatment Outcome