PURPOSE: We reported encouraging early results of allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning in 64 patients who had advanced chronic lymphocytic leukemia (CLL). Here, we have extended the follow-up to a median of 5 years and have included data on an additional 18 patients. PATIENTS AND METHODS: Eighty-two patients, age 42 to 72 years, who had fludarabine-refractory CLL were conditioned with 2 Gy total-body irradiation alone or combined with fludarabine followed by HCT from related (n = 52) or unrelated (n = 30) donors. RESULTS: Complete remission (CR) and partial remission were achieved in 55% and 15% of patients, respectively. Higher CR rates were noted after unrelated HCT (67% v 48%). The 5-year incidences of nonrelapse mortality (NRM), progression/relapse, overall survival, and progression-free survival were 23%, 38%, 50%, and 39%, respectively. Among 25 patients initially reported in CR, 8% relapsed and 8% died as a result of NRM, whereas 84% have remained alive and in CR. Among 14 responding patients who were tested and who had molecular eradication of their disease, two died as a result of NRM, two relapsed, and 10 have remained negative. At 5 years, 76% of living patients were entirely well, whereas 24% continued to receive immunosuppression for chronic graft-versus-host disease; the median performance status in each group was 100% and 90%, respectively. Lymphadenopathy > or = 5 cm, but not cytogenetic abnormalities at HCT, predicted relapse. In a risk-stratification model, patients who had lymphadenopathy less than 5 cm and no comorbidities had a 5-year OS of 71%. CONCLUSION: Nonmyeloablative HCT resulted in a median survival of 5 years for patients who had fludarabine-refractory CLL with sustained remissions and in the continued resolution of chronic graft-versus-host disease in surviving patients.
PURPOSE: We reported encouraging early results of allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning in 64 patients who had advanced chronic lymphocytic leukemia (CLL). Here, we have extended the follow-up to a median of 5 years and have included data on an additional 18 patients. PATIENTS AND METHODS: Eighty-two patients, age 42 to 72 years, who had fludarabine-refractory CLL were conditioned with 2 Gy total-body irradiation alone or combined with fludarabine followed by HCT from related (n = 52) or unrelated (n = 30) donors. RESULTS: Complete remission (CR) and partial remission were achieved in 55% and 15% of patients, respectively. Higher CR rates were noted after unrelated HCT (67% v 48%). The 5-year incidences of nonrelapse mortality (NRM), progression/relapse, overall survival, and progression-free survival were 23%, 38%, 50%, and 39%, respectively. Among 25 patients initially reported in CR, 8% relapsed and 8% died as a result of NRM, whereas 84% have remained alive and in CR. Among 14 responding patients who were tested and who had molecular eradication of their disease, two died as a result of NRM, two relapsed, and 10 have remained negative. At 5 years, 76% of living patients were entirely well, whereas 24% continued to receive immunosuppression for chronic graft-versus-host disease; the median performance status in each group was 100% and 90%, respectively. Lymphadenopathy > or = 5 cm, but not cytogenetic abnormalities at HCT, predicted relapse. In a risk-stratification model, patients who had lymphadenopathy less than 5 cm and no comorbidities had a 5-year OS of 71%. CONCLUSION: Nonmyeloablative HCT resulted in a median survival of 5 years for patients who had fludarabine-refractory CLL with sustained remissions and in the continued resolution of chronic graft-versus-host disease in surviving patients.
Authors: Terry J Hamblin; Jenny A Orchard; Rachel E Ibbotson; Zadie Davis; Peter W Thomas; Freda K Stevenson; David G Oscier Journal: Blood Date: 2002-02-01 Impact factor: 22.113
Authors: John C Byrd; Lisa Smith; Marcy L Hackbarth; Ian W Flinn; Donn Young; John H Proffitt; Nyla A Heerema Journal: Cancer Res Date: 2003-01-01 Impact factor: 12.701
Authors: Alexander Kröber; Till Seiler; Axel Benner; Lars Bullinger; Elsbeth Brückle; Peter Lichter; Hartmut Döhner; Stephan Stilgenbauer Journal: Blood Date: 2002-08-15 Impact factor: 22.113
Authors: Michael J Keating; Ian Flinn; Vinay Jain; Jacques-Louis Binet; Peter Hillmen; John Byrd; Maher Albitar; Lee Brettman; Pedro Santabarbara; Bret Wacker; Kanti R Rai Journal: Blood Date: 2002-05-15 Impact factor: 22.113
Authors: H Döhner; S Stilgenbauer; A Benner; E Leupolt; A Kröber; L Bullinger; K Döhner; M Bentz; P Lichter Journal: N Engl J Med Date: 2000-12-28 Impact factor: 91.245
Authors: John C Byrd; Thomas S Lin; James T Dalton; Di Wu; Mitch A Phelps; Beth Fischer; Mollie Moran; Kristie A Blum; Brad Rovin; Michelle Brooker-McEldowney; Sarah Broering; Larry J Schaaf; Amy J Johnson; David M Lucas; Nyla A Heerema; Gerard Lozanski; Donn C Young; Jose-Ramon Suarez; A Dimitrios Colevas; Michael R Grever Journal: Blood Date: 2006-09-26 Impact factor: 22.113
Authors: Mohamed L Sorror; Rainer F Storb; Brenda M Sandmaier; Richard T Maziarz; Michael A Pulsipher; Michael B Maris; Smita Bhatia; Fabiana Ostronoff; H Joachim Deeg; Karen L Syrjala; Elihu Estey; David G Maloney; Frederick R Appelbaum; Paul J Martin; Barry E Storer Journal: J Clin Oncol Date: 2014-08-25 Impact factor: 44.544
Authors: Tait D Shanafelt; Neil E Kay; Kari G Rabe; David J Inwards; Clive S Zent; Jose F Leis; Susan M Schwager; Carrie A Thompson; Deborah A Bowen; Thomas E Witzig; Susan L Slager; Timothy G Call Journal: Cancer Date: 2011-08-26 Impact factor: 6.860
Authors: Maria L Delioukina; Joycelynne M Palmer; Sandra H Thomas; Amrita Krishnan; Tracey Stiller; Stephen J Forman Journal: Leuk Lymphoma Date: 2011-02-01
Authors: Theis H Terwey; Philipp G Hemmati; Peter Martus; Ekkehart Dietz; Lam G Vuong; Gero Massenkeil; Bernd Dörken; Renate Arnold Journal: Haematologica Date: 2009-12-08 Impact factor: 9.941
Authors: Camille E Puronen; Ryan D Cassaday; Philip A Stevenson; Brenda M Sandmaier; Mary E Flowers; Damian J Green; David G Maloney; Rainer F Storb; Oliver W Press; Ajay K Gopal Journal: Biol Blood Marrow Transplant Date: 2018-07-03 Impact factor: 5.742