Long-term toxicity of allogeneic stem cell transplantation in fludarabine-refractory chronic lymphocytic leukemia

Allogeneic stem cell transplantation (AlloSCT) is the only potentially curative therapy for chronic lymphocytic leukemia (CLL), but high transplant-related morbidity and mortality rates limit its widespread use. Data on the long-term toxicity of alloSCT in this group of patients are lacking. We evaluated response and survival rates as well as measures of quality of life (QOL) in 13 patients with CLL, selected for high-risk progressive disease from the transplant database at the Royal Melbourne Hospital. Seven of 13 patients (54%) achieved a complete remission (CR), of whom four remained in continuous CR at 30-77 months post-transplant. The event-free and overall survival rates were 31% and 38% respectively at 5 years. The transplant-related mortality was 31% at 2 years. Three of 5 patients still alive at last follow-up have resumed part- or full-time employment. AlloSCT is a feasible salvage therapeutic strategy and can provide meaningful disease-free survival and quality of life for some patients with high-risk refractory CLL.