Outcomes of Patients With Chronic Lymphocytic Leukemia and Richter's Transformation After Transplantation Failure.

Abstract

PURPOSE:

Allogeneic stem-cell transplantation (SCT) induces long-term remission in a fraction of patients with high-risk chronic lymphocytic leukemia (CLL) or Richter's transformation (RT). Our purpose was to determine the outcomes of patients whose disease progressed after allogeneic SCT.

PATIENTS AND METHODS:

We retrospectively analyzed the outcomes of 72 patients (52 with CLL and 20 with RT) who underwent allogeneic SCT between 1998 and 2011 and had documented progression after transplantation. Twenty-two (31%) never had a response, and 50 (69%) had a response but experienced relapse after a median of 7 months (range, 2 to 85 months). Forty-eight patients who were receiving or were candidates to receive post-SCT cell-based therapies were not included in this analysis.

RESULTS:

The median age at time of transplantation was 58 years (range, 30 to 72 years). Sixty-two patients (86%) received more than two treatment regimens and 37 (51%) received more than three treatment regimens before SCT. Sixty-six patients (92%) had active disease at the time of transplantation. The 2- and 5-year survival rates were 67% and 38% (patients with CLL) and 36% and 0% (patients with RT). The patients who developed acute or chronic graft-versus-host disease had a longer overall survival (OS; P = .05). In a multivariable analysis, RT or low hemoglobin at the time of SCT predicted shorter OS. Chronic graft-versus-host disease and an initial response to SCT predicted longer OS.

CONCLUSION:

Patients with CLL in whom allogeneic SCT fails may have a response to and benefit from salvage therapies, and their prognosis is relatively good.

• Authors: Uri Rozovski, Ohad Benjamini, Preetesh Jain, Philip A Thompson, William G Wierda, Susan O'Brien, Jan A Burger, Alessandra Ferrajoli, Stefan Faderl, Elizabeth Shpall, Chitra Hosing, Issa F Khouri, Richard Champlin, Michael J Keating, Zeev Estrov
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 33 Issue 14 Pg. 1557-63 (May 10 2015) ISSN: 1527-7755 [Electronic] United States
• PMID: 25847930 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 by American Society of Clinical Oncology.

Chemical References

• Antineoplastic Agents
• Piperidines
• Pyrazoles
• Pyrimidines
• ibrutinib
• Adenine

Topics

• Adenine (analogs & derivatives)
• Adult
• Aged
• Antineoplastic Agents (therapeutic use)
• Chronic Disease
• Disease Progression
• Factor Analysis, Statistical
• Female
• Graft vs Host Disease (diagnosis)
• Humans
• Kaplan-Meier Estimate
• Leukemia, Lymphocytic, Chronic, B-Cell (drug therapy, surgery)
• Male
• Middle Aged
• Piperidines
• Pyrazoles (therapeutic use)
• Pyrimidines (therapeutic use)
• Recurrence
• Retrospective Studies
• Risk Factors
• Salvage Therapy (methods)
• Stem Cell Transplantation
• Transplantation Conditioning
• Transplantation, Homologous
• Treatment Failure
• Treatment Outcome