Outcome of allogeneic stem cell transplantation for B cell chronic lymphocytic leukemia

Z. S. Pavletic, E. R. Arrowsmith, P. J. Bierman, S. A. Goodman, J. M. Vose, S. R. Tarantolo, R. S. Stein, G. Bociek, J. P. Greer, C. D. Wu, J. P. Kollath, D. D. Weisenburger, A. Kessinger, S. N. Wolff, J. O. Armitage, M. R. Bishop

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101 Scopus citations

Abstract

The objective of this study was to describe the outcome of allogeneic stem cell transplantation (alloSCT) in a series of patients with B cell chronic lymphocytic leukemia (B-CLL). Twenty-three B-CLL patients were transplanted between 1988 and 1997 using stem cells from a related (n = 20) or an unrelated donor (n = 3). The median age of the patients was 46 years, and the median number of prior chemotherapy regimens received was two. At transplantation, 14 patients had chemorefractory disease and 12 of these were refractory to fludarabine. The preparative regimens included total body irradiation (TBI) in 22 of the 23 cases. All patients received graft-versus-host disease (GVHD) prophylaxis with cyclosporine and methotrexate. Twenty patients (87%) achieved a complete remission (CR). The incidence of grade II-IV acute GVHD was 54%. Fourteen (61%) patients are alive and disease-free, including two with unrelated donors, at a median of 26 months (range, 9-115 months). Nine patients (39%) have died, one of whom had progressive B-CLL. The only favorable prognostic factor for failure-free survival (FFS) and overall survival (OS) after alloSCT was the use of a cyclophosphamide/TBI rather than an etoposide/ cyclophosphamide/TBI regimen (P = 0.03). The projected 5-year FFS, OS, and relapse rates after alloSCT were 65% (95% CI, 48-88%), 62% (95% CI, 43-88%), and 5% (95%, CI 0-13%), respectively. These findings demonstrate the potential of high-dose therapy and alloSCT for inducing and maintaining a remission in patients with advanced or chemorefractory B-CLL. The low relapse rate may be due to an allogeneic graft-versus-leukemia effect.

Original languageEnglish (US)
Pages (from-to)717-722
Number of pages6
JournalBone marrow transplantation
Volume25
Issue number7
DOIs
StatePublished - 2000

Keywords

  • B cell
  • Chronic leukemia
  • Hematopoietic stem cell transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Pavletic, Z. S., Arrowsmith, E. R., Bierman, P. J., Goodman, S. A., Vose, J. M., Tarantolo, S. R., Stein, R. S., Bociek, G., Greer, J. P., Wu, C. D., Kollath, J. P., Weisenburger, D. D., Kessinger, A., Wolff, S. N., Armitage, J. O., & Bishop, M. R. (2000). Outcome of allogeneic stem cell transplantation for B cell chronic lymphocytic leukemia. Bone marrow transplantation, 25(7), 717-722. https://doi.org/10.1038/sj.bmt.1702237