TY - JOUR
T1 - Reduced intensity conditioning regimens including alkylating chemotherapy do not alter survival outcomes after allogeneic hematopoietic cell transplantation in chronic lymphocytic leukemia compared to low-intensity non-myeloablative conditioning
AU - Andersen, Niels Smedegaard
AU - Bornhaeuser, Martin
AU - Gramatzki, Martin
AU - Dreger, Peter
AU - Vitek, Antonin
AU - Karas, Michal
AU - Michallet, Mauricette
AU - Moreno, Carol
AU - van Gelder, Michel
AU - Henseler, Anja
AU - de Wreede, Liesbeth C.
AU - Schoenland, Stefan
AU - Kroeger, Nicolaus
AU - Schetelig, Johannes
AU - CLL subcommittee, Chronic Malignancies Working Party
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/11
Y1 - 2019/11
N2 - Purpose The optimal dose intensity for conditioning prior to allogeneic hematopoietic stem cell transplantation (alloHSCT) for chronic lymphocytic leukemia (CLL) is unknown. Methods We retrospectively compared outcomes of patients who received a first alloHCST after non-myeloablative (NMA) and reduced intensity conditioning (RIC). Data of 432 patients with a median age of 55 years were included, of which 86 patients underwent NMA and 346 RIC. Results The median follow-up after alloHSCT was 4.3 years. Compared to the RIC group, more NMA patients had purine-analog-sensitive disease, were in complete remission and received matched related donor transplantation. After RIC, the probabilities for 5-year OS, EFS, CIR, and NRM were 46%, 38%, 28%, and 35% and after NMA the respective probabilities were 52%, 43%, 25%, and 32%. In multivariate analysis, remission status prior to conditioning but not RIC versus NMA conditioning had a significant impact on CIR, EFS, and OS. Conclusion Presumed higher anti-leukemic activity of RIC versus NMA conditioning did not translate into better outcomes after alloHSCT, but better remission status prior to conditioning did. Effective pathway inhibitor-based salvage therapies combined with NMA conditioning might thus represent the most attractive contemporary approach for alloHSCT for patients with CLL.
AB - Purpose The optimal dose intensity for conditioning prior to allogeneic hematopoietic stem cell transplantation (alloHSCT) for chronic lymphocytic leukemia (CLL) is unknown. Methods We retrospectively compared outcomes of patients who received a first alloHCST after non-myeloablative (NMA) and reduced intensity conditioning (RIC). Data of 432 patients with a median age of 55 years were included, of which 86 patients underwent NMA and 346 RIC. Results The median follow-up after alloHSCT was 4.3 years. Compared to the RIC group, more NMA patients had purine-analog-sensitive disease, were in complete remission and received matched related donor transplantation. After RIC, the probabilities for 5-year OS, EFS, CIR, and NRM were 46%, 38%, 28%, and 35% and after NMA the respective probabilities were 52%, 43%, 25%, and 32%. In multivariate analysis, remission status prior to conditioning but not RIC versus NMA conditioning had a significant impact on CIR, EFS, and OS. Conclusion Presumed higher anti-leukemic activity of RIC versus NMA conditioning did not translate into better outcomes after alloHSCT, but better remission status prior to conditioning did. Effective pathway inhibitor-based salvage therapies combined with NMA conditioning might thus represent the most attractive contemporary approach for alloHSCT for patients with CLL.
KW - Relapsed
KW - refractory chronic lymphocytic leukemia
KW - Allogeneic hematopoietic stem cell transplantation
KW - Nonmyeloablative
KW - reduced intensity conditioning
KW - TOTAL-BODY IRRADIATION
KW - RETROSPECTIVE ANALYSIS
KW - EUROPEAN-SOCIETY
KW - FOLLOW-UP
KW - MARROW-TRANSPLANTATION
KW - CLL
KW - LYMPHOMA
KW - BLOOD
KW - FLUDARABINE
KW - FAILURE
U2 - 10.1007/s00432-019-03014-x
DO - 10.1007/s00432-019-03014-x
M3 - Article
C2 - 31468122
SN - 0171-5216
VL - 145
SP - 2823
EP - 2834
JO - Journal of Cancer Research and Clinical Oncology
JF - Journal of Cancer Research and Clinical Oncology
IS - 11
ER -