High incidence of chronic graft-versus-host disease after myeloablative allogeneic stem cell transplantation for chronic lymphocytic leukemia in Sweden: graft-versus-leukemia effect protects against relapse.

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a potentially curative treatment option for eligible patients with chronic lymphocytic leukemia (CLL). However, it is known that cure of CLL is only possible if a graft-versus-leukemia effect is present. Between 1994 and 2007, 48 adults underwent allo-SCT for poor-risk CLL in Sweden. Of these, ten (21%) patients aged 24-53 years (median: 46 years) received myeloablative conditioning (MAC), based on TBI and cyclophosphamide. All MAC patients had refractory, poorly controlled CLL before allo-SCT (partial remission in 9/10 patients and progressive disease in one). The cumulative incidence of acute graft-versus-host disease (GVHD) grades II-IV was 30%. Nine patients developed chronic GVHD; extensive in four. Rates of nonrelapse mortality at 1, 3 and 10 years were 0, 10 and 20%, respectively. Two patients relapsed 36 and 53 months after transplantation. Six patients were still alive after a median follow-up time of 11.5 years (range 5.9-13.7). The probabilities of relapse-free and overall survival from 1, 3 and 5 years after transplantation were 100, 90 and 70%, and 100, 90 and 80%, respectively. Nevertheless, our analysis of long-term outcome after MAC allo-SCT for CLL suggests that younger patients with poorly controlled CLL may benefit from MAC allo-SCT.

• Authors: Maciej Machaczka, Jan-Erik Johansson, Mats Remberger, Helene Hallböök, Vladimir Lj Lazarevic, Björn Engelbrekt Wahlin, Hamdy Omar, Anders Wahlin, Gunnar Juliusson, Eva Kimby, Hans Hägglund
• Journal: Medical oncology (Northwood, London, England) (Med Oncol) Vol. 30 Issue 4 Pg. 762 (Dec 2013) ISSN: 1559-131X [Electronic] United States
• PMID: 24214180 (Publication Type: Journal Article)

Topics

• Adult
• Disease Progression
• Female
• Graft vs Host Disease (epidemiology)
• Graft vs Leukemia Effect
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Kaplan-Meier Estimate
• Leukemia, Lymphocytic, Chronic, B-Cell (epidemiology, mortality, therapy)
• Male
• Middle Aged
• Sweden (epidemiology)
• Transplantation, Homologous
• Young Adult