Unrelated donor marrow transplantation for B-cell chronic lymphocytic leukemia after using myeloablative conditioning

Results from the center for international blood and marrow transplant research

Steven Z. Pavletic, Issa F. Khouri, Michael Haagenson, Roberta J. King, Philip J. Bierman, Michael R. Bishop, Michael Carston, Sergio Giralt, Arturo Molina, Edward A. Copelan, Olle Ringdén, Vivek Roy, Karen Ballen, Douglas R. Adkins, Philip McCarthy, Daniel Weisdorf, Emili Montserrat, Claudio Anasetti

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Purpose: To determine the role of myeloablative conditioning and unrelated donor (URD) bone marrow transplantation in the treatment of patients with advanced B-cell chronic lymphocytic leukemia (CLL). Patients and Methods: A total of 38 CLL patients received a matched URD transplant using bone marrow procured by the National Marrow Donor Program. The median age was 45 years (range, 26 to 57 years), the median time from diagnosis was 51 months, and the median number of prior chemotherapy regimens was three. Fifty-five percent of patients were chemotherapy refractory and 89% had received fludarabine. Conditioning included total-body irradiation in 92% of patients. Graft-versus-host disease (GVHD) prophylaxis consisted of methotrexate with cyclosporine or tacrolimus for 82% of patients. Results: Twenty-one patients (58%) achieved complete response and six (17%) achieved partial response. Incidences of grades 2 to 4 acute GVHD were 45% at 100 days and incidences of chronic GVHD were 85% at 5 years. Eleven patients are alive and disease free at a median of 6 years (range, 3.0 to 9.0 years). Five-year overall survival, failure-free survival, disease progression rates, and treatment-related mortality (TRM) were 33%, 30%, 32%, and 38% respectively. Conclusion: These data demonstrate that lasting remissions can be achieved after URD transplantation in patients with advanced CLL. High TRM suggest that myeloablative conditioning and HLA-mismatched donors should be avoided in future protocols, and it is mandatory to investigate transplant strategies with a lower morbidity and mortality, including the use of nonmyeloablative regimens.

Original languageEnglish (US)
Pages (from-to)5788-5794
Number of pages7
JournalJournal of Clinical Oncology
Volume23
Issue number24
DOIs
StatePublished - Dec 1 2005

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Unrelated Donors
B-Cell Chronic Lymphocytic Leukemia
Transplantation
Bone Marrow
Transplants
Research
Graft vs Host Disease
Mortality
Tissue Donors
Drug Therapy
Survival
Whole-Body Irradiation
Incidence
Tacrolimus
Bone Marrow Transplantation
Methotrexate
Cyclosporine
Disease Progression
Therapeutics
Morbidity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Unrelated donor marrow transplantation for B-cell chronic lymphocytic leukemia after using myeloablative conditioning : Results from the center for international blood and marrow transplant research. / Pavletic, Steven Z.; Khouri, Issa F.; Haagenson, Michael; King, Roberta J.; Bierman, Philip J.; Bishop, Michael R.; Carston, Michael; Giralt, Sergio; Molina, Arturo; Copelan, Edward A.; Ringdén, Olle; Roy, Vivek; Ballen, Karen; Adkins, Douglas R.; McCarthy, Philip; Weisdorf, Daniel; Montserrat, Emili; Anasetti, Claudio.

In: Journal of Clinical Oncology, Vol. 23, No. 24, 01.12.2005, p. 5788-5794.

Research output: Contribution to journalArticle

Pavletic, SZ, Khouri, IF, Haagenson, M, King, RJ, Bierman, PJ, Bishop, MR, Carston, M, Giralt, S, Molina, A, Copelan, EA, Ringdén, O, Roy, V, Ballen, K, Adkins, DR, McCarthy, P, Weisdorf, D, Montserrat, E & Anasetti, C 2005, 'Unrelated donor marrow transplantation for B-cell chronic lymphocytic leukemia after using myeloablative conditioning: Results from the center for international blood and marrow transplant research', Journal of Clinical Oncology, vol. 23, no. 24, pp. 5788-5794. https://doi.org/10.1200/JCO.2005.03.962
Pavletic, Steven Z. ; Khouri, Issa F. ; Haagenson, Michael ; King, Roberta J. ; Bierman, Philip J. ; Bishop, Michael R. ; Carston, Michael ; Giralt, Sergio ; Molina, Arturo ; Copelan, Edward A. ; Ringdén, Olle ; Roy, Vivek ; Ballen, Karen ; Adkins, Douglas R. ; McCarthy, Philip ; Weisdorf, Daniel ; Montserrat, Emili ; Anasetti, Claudio. / Unrelated donor marrow transplantation for B-cell chronic lymphocytic leukemia after using myeloablative conditioning : Results from the center for international blood and marrow transplant research. In: Journal of Clinical Oncology. 2005 ; Vol. 23, No. 24. pp. 5788-5794.
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abstract = "Purpose: To determine the role of myeloablative conditioning and unrelated donor (URD) bone marrow transplantation in the treatment of patients with advanced B-cell chronic lymphocytic leukemia (CLL). Patients and Methods: A total of 38 CLL patients received a matched URD transplant using bone marrow procured by the National Marrow Donor Program. The median age was 45 years (range, 26 to 57 years), the median time from diagnosis was 51 months, and the median number of prior chemotherapy regimens was three. Fifty-five percent of patients were chemotherapy refractory and 89{\%} had received fludarabine. Conditioning included total-body irradiation in 92{\%} of patients. Graft-versus-host disease (GVHD) prophylaxis consisted of methotrexate with cyclosporine or tacrolimus for 82{\%} of patients. Results: Twenty-one patients (58{\%}) achieved complete response and six (17{\%}) achieved partial response. Incidences of grades 2 to 4 acute GVHD were 45{\%} at 100 days and incidences of chronic GVHD were 85{\%} at 5 years. Eleven patients are alive and disease free at a median of 6 years (range, 3.0 to 9.0 years). Five-year overall survival, failure-free survival, disease progression rates, and treatment-related mortality (TRM) were 33{\%}, 30{\%}, 32{\%}, and 38{\%} respectively. Conclusion: These data demonstrate that lasting remissions can be achieved after URD transplantation in patients with advanced CLL. High TRM suggest that myeloablative conditioning and HLA-mismatched donors should be avoided in future protocols, and it is mandatory to investigate transplant strategies with a lower morbidity and mortality, including the use of nonmyeloablative regimens.",
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AU - Khouri, Issa F.

AU - Haagenson, Michael

AU - King, Roberta J.

AU - Bierman, Philip J.

AU - Bishop, Michael R.

AU - Carston, Michael

AU - Giralt, Sergio

AU - Molina, Arturo

AU - Copelan, Edward A.

AU - Ringdén, Olle

AU - Roy, Vivek

AU - Ballen, Karen

AU - Adkins, Douglas R.

AU - McCarthy, Philip

AU - Weisdorf, Daniel

AU - Montserrat, Emili

AU - Anasetti, Claudio

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N2 - Purpose: To determine the role of myeloablative conditioning and unrelated donor (URD) bone marrow transplantation in the treatment of patients with advanced B-cell chronic lymphocytic leukemia (CLL). Patients and Methods: A total of 38 CLL patients received a matched URD transplant using bone marrow procured by the National Marrow Donor Program. The median age was 45 years (range, 26 to 57 years), the median time from diagnosis was 51 months, and the median number of prior chemotherapy regimens was three. Fifty-five percent of patients were chemotherapy refractory and 89% had received fludarabine. Conditioning included total-body irradiation in 92% of patients. Graft-versus-host disease (GVHD) prophylaxis consisted of methotrexate with cyclosporine or tacrolimus for 82% of patients. Results: Twenty-one patients (58%) achieved complete response and six (17%) achieved partial response. Incidences of grades 2 to 4 acute GVHD were 45% at 100 days and incidences of chronic GVHD were 85% at 5 years. Eleven patients are alive and disease free at a median of 6 years (range, 3.0 to 9.0 years). Five-year overall survival, failure-free survival, disease progression rates, and treatment-related mortality (TRM) were 33%, 30%, 32%, and 38% respectively. Conclusion: These data demonstrate that lasting remissions can be achieved after URD transplantation in patients with advanced CLL. High TRM suggest that myeloablative conditioning and HLA-mismatched donors should be avoided in future protocols, and it is mandatory to investigate transplant strategies with a lower morbidity and mortality, including the use of nonmyeloablative regimens.

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