Premium
Allogeneic haematopoietic stem cell transplantation for chronic lymphocytic leukaemia: outcome in a 20‐year cohort
Author(s) -
Toze Cynthia L.,
Dalal Chinmay B.,
Nevill Thomas J.,
Gillan Tanya L.,
Abou Mourad Yasser R.,
Barnett Michael J.,
Broady Raewyn C.,
Forrest Donna L.,
Hogge Donna E.,
Nantel Stephen H.,
Power Maryse M.,
Song Kevin W.,
Sutherland Heather J.,
Smith Clayton A.,
Narayanan Sujaatha,
Young Sean S.,
Connors Joseph M.,
Shepherd John D.
Publication year - 2012
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2012.09170.x
Subject(s) - stem cell , haematopoiesis , transplantation , medicine , cohort , hematology , oncology , immunology , hematopoietic stem cell transplantation , biology , genetics
Summary The curative potential of allogeneic haematopoietic stem cell transplant (allo HSCT ) in chronic lymphocytic leukaemia CLL is established, with a demonstrated role for graft‐versus‐leukaemia and less certainty for other factors in determining outcome. The first two decades of CLL patients proceeding to allo HSCT at the Leukaemia/Bone Marrow Transplant Program of British Columbia ( n = 49 consecutive, 1991–2009) were studied to clarify factors predicting outcome. The donor was related in 29 (59%) and unrelated in 20 (41%). Conditioning was reduced‐intensity in 27 (55%) and myeloablative in 22 (45%). Thirty‐one of 49 patients survive with median follow‐up of 5 years (0·2–15). Cumulative incidence of non‐relapse mortality; complete remission ( CR ); clearance of fluorescence in situ hybridization ( FISH ) abnormality and progression at 10 years was 36%; 69%; 55% and 22%. Overall survival ( OS ) was 63% at 2 years; 55% at 5 years and beyond. Factors predicting OS ( P value by log rank <0·05) were: comorbidity index <3, FISH rank (Dohner) and 17p deletion, alemtuzumab pre‐ HSCT , achievement of CR post‐ HSCT , donor chimerism >90%, clearance of FISH abnormality post‐ HSCT and absence of high‐grade (3–4) graft‐versus‐host disease. Results from this province‐wide, two‐decade cohort demonstrated that a substantial proportion of patients with high‐risk CLL become long term disease‐free survivors.