Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning

Mohamed L. Sorror, Barry E. Storer, Brenda M. Sandmaier, Michael Maris, Judith Shizuru, Richard Maziarz, Edward Agura, Thomas R. Chauncey, Michael A. Pulsipher, Peter A. McSweeney, James C. Wade, Benedetto Bruno, Amelia Langston, Jerald Radich, Dietger Niederwieser, Karl G. Blume, Rainer Storb, David G. Maloney

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Abstract

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 ≥ 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.

Original languageEnglish (US)
Pages (from-to)4912-4920
Number of pages9
JournalJournal of Clinical Oncology
Volume26
Issue number30
DOIs
StatePublished - Oct 20 2008

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Cell Transplantation
B-Cell Chronic Lymphocytic Leukemia
Graft vs Host Disease
Mortality
Disease Eradication
Recurrence
Survival
Whole-Body Irradiation
Chromosome Aberrations
Immunosuppression
Disease-Free Survival
Comorbidity
Tissue Donors

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. / Sorror, Mohamed L.; Storer, Barry E.; Sandmaier, Brenda M.; Maris, Michael; Shizuru, Judith; Maziarz, Richard; Agura, Edward; Chauncey, Thomas R.; Pulsipher, Michael A.; McSweeney, Peter A.; Wade, James C.; Bruno, Benedetto; Langston, Amelia; Radich, Jerald; Niederwieser, Dietger; Blume, Karl G.; Storb, Rainer; Maloney, David G.

In: Journal of Clinical Oncology, Vol. 26, No. 30, 20.10.2008, p. 4912-4920.

Research output: Contribution to journalArticle

Sorror, ML, Storer, BE, Sandmaier, BM, Maris, M, Shizuru, J, Maziarz, R, Agura, E, Chauncey, TR, Pulsipher, MA, McSweeney, PA, Wade, JC, Bruno, B, Langston, A, Radich, J, Niederwieser, D, Blume, KG, Storb, R & Maloney, DG 2008, 'Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning', Journal of Clinical Oncology, vol. 26, no. 30, pp. 4912-4920. https://doi.org/10.1200/JCO.2007.15.4757
Sorror, Mohamed L. ; Storer, Barry E. ; Sandmaier, Brenda M. ; Maris, Michael ; Shizuru, Judith ; Maziarz, Richard ; Agura, Edward ; Chauncey, Thomas R. ; Pulsipher, Michael A. ; McSweeney, Peter A. ; Wade, James C. ; Bruno, Benedetto ; Langston, Amelia ; Radich, Jerald ; Niederwieser, Dietger ; Blume, Karl G. ; Storb, Rainer ; Maloney, David G. / Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 30. pp. 4912-4920.
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AU - Sorror, Mohamed L.

AU - Storer, Barry E.

AU - Sandmaier, Brenda M.

AU - Maris, Michael

AU - Shizuru, Judith

AU - Maziarz, Richard

AU - Agura, Edward

AU - Chauncey, Thomas R.

AU - Pulsipher, Michael A.

AU - McSweeney, Peter A.

AU - Wade, James C.

AU - Bruno, Benedetto

AU - Langston, Amelia

AU - Radich, Jerald

AU - Niederwieser, Dietger

AU - Blume, Karl G.

AU - Storb, Rainer

AU - Maloney, David G.

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N2 - 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 ≥ 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.

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