Open AccessIdelalisib treatment prior to allogeneic stem cell transplantation for patients with chronic lymphocytic leukemia: a report from the EBMT chronic malignancies working party
Author(s) -
Johannes Schetelig,
Patrice Chevallier,
Michel van Gelder,
Jennifer Hoek,
Olivier Hermine,
Ronjon Chakraverty,
Paul Browne,
Noël Milpied,
Michele Malagola,
Gèrard Socié,
Julio Delgado,
Eric Deconinck,
Ghandi Damaj,
Sylvette Maury,
Dietrich Beelen,
Stéphanie Nguyen Quoc,
Shankara Paneesha,
Arne Brecht,
Jiřı́ Mayer,
Mathilde HunaultBerger,
Jörg Bittenbring,
Catherine Thiéblemont,
Stéphane Leprêtre,
Henning Baldauf,
Liesbeth C. de Wreede,
Olivier Tournilhac,
Ibrahim YakoubAgha,
Nicolaus Kröger,
Peter Dreger
Publication year - 2020
Publication title -
bone marrow transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 127
eISSN - 1476-5365
pISSN - 0268-3369
DOI - 10.1038/s41409-020-01069-w
Subject(s) - medicine , idelalisib , chronic lymphocytic leukemia , chemoimmunotherapy , cumulative incidence , transplantation , hematopoietic stem cell transplantation , oncology , univariate analysis , fludarabine , surgery , ibrutinib , leukemia , chemotherapy , multivariate analysis , cyclophosphamide
No studies have been reported so far on bridging treatment with idelalisib for patients with chronic lymphocytic leukemia (CLL) prior to allogeneic hematopoietic cell transplantation (alloHCT). To study potential carry-over effects of idelalisib and to assess the impact of pathway-inhibitor (PI) failure we performed a retrospective EBMT registry-based study. Patients with CLL who had a history of idelalisib treatment and received a first alloHCT between 2015 and 2017 were eligible. Data on 72 patients (median age 58 years) were analyzed. Forty percent of patients had TP53 mut/del CLL and 64% had failed on at least one PI. No primary graft failure occurred. Cumulative incidences of acute GVHD °II-IV and chronic GVHD were 51% and 39%, respectively. Estimates for 2-year overall survival (OS), progression-free survival (PFS), and cumulative incidences of relapse/progression (CIR) and non-relapse mortality NRM were 59%, 44%, 25%, and 31%. In univariate analysis, drug sensitivity was a strong risk factor. For patients who had failed neither PI treatment nor chemoimmunotherapy (CIT) the corresponding 2-year estimates were 73%, 65%, 15%, and 20%, respectively. In conclusion, idelalisib may be considered as an option for bridging therapy prior to alloHCT. Owing to the high risk for acute GVHD intensified clinical monitoring is warranted.