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A single-institution study of allograft outcomes for chronic lymphocytic leukaemia over 20 years
Rory Bennett1, Thomas Frawley1, Philip A Thompson1,2
1Department of Clinical Haematology, Royal Melbourne Hospital & Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Insights
Allogeneic stem cell transplantation (alloSCT) offers curative potential for high-risk chronic lymphocytic leukemia (CLL). This study details institutional alloSCT outcomes, providing a benchmark for future immunotherapies in CLL treatment.
Area of Science:
- Hematology
- Oncology
- Immunotherapy
Background:
- Allogeneic stem cell transplantation (alloSCT) is a potentially curative therapy for high-risk chronic lymphocytic leukemia (CLL).
- The advent of novel immunotherapies like CAR T-cell therapies and bispecific antibodies may impact the future utilization of alloSCT.
- Establishing institutional benchmarks for alloSCT outcomes is crucial for comparing future treatment modalities.
Purpose of the Study:
- To retrospectively analyze and report institutional outcomes for alloSCT in patients with CLL.
- To provide local data for comparison with outcomes from emerging immunotherapies.
- To inform the ongoing discussion regarding the role of alloSCT in CLL management.
Main Methods:
- Retrospective analysis of patients with CLL undergoing alloSCT from an institutional database.
- Kaplan-Meier estimates for survival outcomes (PFS, OS).
- Gray's competing incidence analyses for cumulative incidence of relapse (CIR) and non-relapse mortality (NRM).
Main Results:
- Sixty-two CLL patients (median age 54 years) underwent alloSCT between 2000-2022; 39% had complex karyotype, 35.4% had del(17p).
- Two-year PFS and OS were 57.7% and 74%, respectively; 10-year PFS and OS were 38.2% and 50.8%.
- Del(17p) was linked to inferior PFS, and age ≥54 years to inferior OS. CIR was 16.3% and NRM was 18.2% at 2 years.
Conclusions:
- Institutional alloSCT outcomes for CLL align with historical data from the chemoimmunotherapy era.
- While recent data suggest improved post-alloSCT survival, direct impact of novel agents needs further evaluation.
- Recommendations for the current role of alloSCT in CLL therapy are provided based on these findings.
Background:
Allogeneic stem cell transplantation (alloSCT) is an established potentially curative therapy for patients with high-risk chronic lymphocytic leukaemia (CLL). Future availability of chimeric antigen receptor T-cell therapies and bispecific antibodies may further reduce utilisation of alloSCT.
Aim:
This retrospective analysis sought to describe institutional outcomes for alloSCT for CLL, to which future outcomes following immunotherapies may be compared locally.
Methods:
Patients with CLL in the institutional alloSCT database were identified. Kaplan-Meier estimates were used to assess survival outcomes, and Gray's competing incidence analyses were used for cumulative incidence of relapse (CIR) and non-relapse mortality (NRM).
Results:
Sixty-two patients with CLL of median age 54 years (range 25-75), including 17 with prior Richter transformation, underwent alloSCT between 2000 and 2022. A total of 39% and 35.4% of tested patients harboured complex karyotype and del(17p) respectively. Median follow-up for survivors was 9.2 years. Two-year progression-free survival (PFS), overall survival (OS), CIR and NRM rates were 57.7%, 74%, 16.3% and 18.2% respectively. Ten-year PFS and OS were 38.2% and 50.8% respectively. Twenty-nine deaths occurred during follow-up, including 14 without prior CLL relapse. Del(17p) abnormality was associated with inferior PFS, and age ≥54 years at alloSCT was associated with inferior OS.
Conclusions:
Survival outcomes from this study align with prospective and retrospective data published from the chemoimmunotherapy era of CLL treatment. Although more recent data suggest improved post-alloSCT survival outcomes, data assessing the impact of novel agents distinct from improved alloSCT care are lacking. Our recommendations for the current role of alloSCT in CLL therapy are summarised.
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