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Published on: March 26, 2018
Reduced intensity versus full myeloablative stem cell transplant for advanced CLL
E Peres1, T Braun, O Krijanovski
1Blood and Marrow Transplant Program, Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. edwardpe@umich.edu
Insights
Reduced-intensity conditioning (RIC) allogeneic stem cell transplants offer improved survival for advanced chronic lymphocytic leukemia (CLL) patients compared to full-intensity conditioning (FIC). RIC significantly reduces transplant-related mortality, making it a safer curative option.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Chronic lymphocytic leukemia (CLL) is generally incurable with standard treatments.
- Allogeneic hematopoietic stem cell transplant (HCT) presents a potential curative option for advanced CLL.
- This study evaluates HCT outcomes in advanced CLL patients.
Purpose of the Study:
- To compare the efficacy and safety of reduced-intensity conditioning (RIC) versus full-intensity conditioning (FIC) allogeneic HCT in advanced CLL.
- To assess overall survival (OS), transplant-related mortality (TRM), and relapse rates between RIC and FIC groups.
- To identify factors influencing outcomes in advanced CLL patients undergoing HCT.
Main Methods:
- Retrospective analysis of 50 advanced CLL patients undergoing allogeneic HCT between 1996-2006.
- Patients were divided into RIC (n=21) and FIC (n=29) groups.
- FIC regimens included cyclophosphamide (CY), etoposide, and BCNU, or busulfan (BU) and CY.
Main Results:
- RIC recipients were older (median 54 vs 51 years) and had more unrelated donors (62% vs 31%).
- Despite these factors, 5-year OS was significantly higher in the RIC group (63%) compared to FIC (18%).
- TRM was substantially lower in the RIC group (14% at day 100) versus FIC (27% at day 100).
Conclusions:
- Reduced-intensity conditioning (RIC) allogeneic HCT demonstrates a favorable outcome for advanced CLL patients compared to full-intensity conditioning (FIC).
- RIC significantly lowers transplant-related mortality, improving survival rates in this patient population.
- RIC should be considered a preferred conditioning regimen for advanced CLL patients undergoing allogeneic HCT.
Abstract:
CLL remains incurable with the standard therapy. Allogeneic hematopoietic stem cell transplant may be curative. We examined 50 patients with advanced CLL who underwent allogeneic HCT at the University of Michigan between 1996 and 2006. Twenty-one patients received reduced-intensity conditioning (RIC) and twenty-nine patients received full-intensity conditioning (FIC) consisting of CY, etoposide and BCNU (n=20) or BU and CY (n=9). RIC recipients were older than FIC recipients (median age 54 vs 51, P=0.009). There were no statistically significant differences between groups in terms of the number of earlier therapies or patients with adverse cytogenetics. There were more unrelated donors in the RIC group 62% than in the FIC group 31% (P=0.030). Despite their older age and greater use of URD, the 5-year overall survival (OS) rate was 63% in the RIC group as compared with 18% in the FIC group (P=0.006). The primary cause of inferior survival in the FIC recipients was TRM, which was twice as high at day 100 for the FIC group 27% compared with the RIC group 14% (P=0.005). The relapse rate was 15% regardless with the majority of relapses occurring after day 100. These results suggest a favorable outcome for advanced CLL who undergo a RIC regimen compared with FIC.
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