19 Years of Experience with Allo Transplants for CLL

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Bone Marrow Transplant 2002 May;29(10):817-23

Allogeneic related donor hematopoietic stem cell

transplantation for treatment of chronic lymphocytic

leukemia.

Doney KC, Chauncey T, Appelbaum FR; For the Seattle

Bone Marrow Transplant Team.

Clinical Research Division, Fred Hutchinson Cancer

Research Center, Seattle, WA, USA, and Division of

Oncology, University of Washington Medical Center,

Seattle, WA, USA.

Between 1980 and 1999, 25 patients with chronic

lymphocytic leukemia (CLL) received related donor

hematopoietic stem cell transplants. Median patient

age was 46.6 years.

Preparative regimens included busulfan (BU) plus

cyclophosphamide (CY), CY plus TBI, and etoposide, CY

plus TBI. Twenty-one donors were HLA-identical

siblings, one was a DR mismatched sibling, and three

were identical twins.

Bone marrow was the source of hematopoietic stem cells

in 22 cases and G-CSF stimulated peripheral blood in

three cases. Most patients received methotrexate and

cyclosporine for GVHD prophylaxis.

Fourteen patients developed grades 2-4 acute GVHD and

10 developed clinical extensive chronic GVHD. Late

clearance of CLL cells was associated with the

development of chronic GVHD in one patient. Two

patients had recurrent CLL.

Nonrelapse mortality at day 100 was 57% for the seven

patients conditioned with BU/CY and 17% for the 18

patients conditioned with TBI-containing regimens.

Actuarial survival at 5 years for the 25 patients is

32%.

All patients who received BU/CY died within 3 years of

transplant. For the 14 patients transplanted since

1992 and who received TBI, actuarial 5-year survival

is 56%.

The maximum response of CLL to hematopoietic cell

transplantation may be delayed, but long-term

disease-free survival can be achieved.

PMID: 12058231 [PubMed - in process]

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