TY - JOUR
T1 - Outcomes of human leukocyte antigen-matched sibling donor hematopoietic cell transplantation in chronic lymphocytic leukemia
T2 - Myeloablative versus reduced-intensity conditioning regimens
AU - Sobecks, Ronald M.
AU - Leis, Jose F.
AU - Gale, Robert Peter
AU - Ahn, Kwang Woo
AU - Zhu, Xiaochun
AU - Sabloff, Mitchell
AU - de Lima, Marcos
AU - Brown, Jennifer R.
AU - Inamoto, Yoshihiro
AU - Hale, Gregory A.
AU - Aljurf, Mahmoud D.
AU - Kamble, Rammurti T.
AU - Hsu, Jack W.
AU - Pavletic, Steven Z.
AU - Wirk, Baldeep
AU - Seftel, Matthew D.
AU - Lewis, Ian D.
AU - Alyea, Edwin P.
AU - Cortes, Jorge
AU - Kalaycio, Matt E.
AU - Maziarz, Richard T.
AU - Saber, Wael
PY - 2014/9
Y1 - 2014/9
N2 - Allogeneic hematopoietic cell transplantation (HCT) can cure some chronic lymphocytic leukemia (CLL) subjects. This study compared outcomes of myeloablative (MA) and reduced-intensity conditioning (RIC) transplants from HLA-matched sibling donors (MSD) for CLL. From 1995 to 2007, information regarding 297 CLL subjects was reported to the Center of International Blood and Marrow Transplant Research; of these, 163 underwent MA and 134 underwent RIC MSD HCT. The MA subjects underwent transplantation less often after 2000 and less commonly received antithymocyte globulin (4% versus 13%, P= .004) or prior antibody therapy (14% versus 53%; P < .001). RIC was associated with a greater likelihood of platelet recovery and less grade 2 to 4 acute graft-versus-host disease compared with MA conditioning. One- and 5-year treatment-related mortality (TRM) were 24% (95% confidence intervals [CI], 16% to 33%) versus 37% (95% CI, 30% to 45%; P= .023), and 40% (95% CI, 29% to 51%) versus 54% (95% CI, 46% to 62%; P= .036), respectively, and the relapse/progression rates at 1 and 5years were 21% (95% CI, 14% to 29%) versus 10% (95% CI, 6% to 15%; P=020), and 35% (95% CI, 26% to 46%) versus 17% (95% CI, 12% to 24%; P= .003), respectively. MA conditioning was associated with better progression-free (PFS) (relative risk, .60; 95% CI, .37 to .97; P= .038) and 3-year survival in transplantations before 2001, but for subsequent years, RIC was associated with better PFS and survival (relative risk, 1.49 [95% CI, .92 to 2.42]; P= .10; and relative risk, 1.86 [95% CI, 1.11 to 3.13]; P=019). Pretransplantation disease status was the most important predictor of relapse (P= .003) and PFS (P= .0007) for both forms of transplantation conditioning. MA and RIC MSD transplantations are effective for CLL. Future strategies to decrease TRM and reduce relapses are warranted.
AB - Allogeneic hematopoietic cell transplantation (HCT) can cure some chronic lymphocytic leukemia (CLL) subjects. This study compared outcomes of myeloablative (MA) and reduced-intensity conditioning (RIC) transplants from HLA-matched sibling donors (MSD) for CLL. From 1995 to 2007, information regarding 297 CLL subjects was reported to the Center of International Blood and Marrow Transplant Research; of these, 163 underwent MA and 134 underwent RIC MSD HCT. The MA subjects underwent transplantation less often after 2000 and less commonly received antithymocyte globulin (4% versus 13%, P= .004) or prior antibody therapy (14% versus 53%; P < .001). RIC was associated with a greater likelihood of platelet recovery and less grade 2 to 4 acute graft-versus-host disease compared with MA conditioning. One- and 5-year treatment-related mortality (TRM) were 24% (95% confidence intervals [CI], 16% to 33%) versus 37% (95% CI, 30% to 45%; P= .023), and 40% (95% CI, 29% to 51%) versus 54% (95% CI, 46% to 62%; P= .036), respectively, and the relapse/progression rates at 1 and 5years were 21% (95% CI, 14% to 29%) versus 10% (95% CI, 6% to 15%; P=020), and 35% (95% CI, 26% to 46%) versus 17% (95% CI, 12% to 24%; P= .003), respectively. MA conditioning was associated with better progression-free (PFS) (relative risk, .60; 95% CI, .37 to .97; P= .038) and 3-year survival in transplantations before 2001, but for subsequent years, RIC was associated with better PFS and survival (relative risk, 1.49 [95% CI, .92 to 2.42]; P= .10; and relative risk, 1.86 [95% CI, 1.11 to 3.13]; P=019). Pretransplantation disease status was the most important predictor of relapse (P= .003) and PFS (P= .0007) for both forms of transplantation conditioning. MA and RIC MSD transplantations are effective for CLL. Future strategies to decrease TRM and reduce relapses are warranted.
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U2 - 10.1016/j.bbmt.2014.05.020
DO - 10.1016/j.bbmt.2014.05.020
M3 - Article
C2 - 24880021
AN - SCOPUS:84905570108
SN - 1083-8791
VL - 20
SP - 1390
EP - 1398
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 9
ER -