Reduced-intensity conditioning hematopoietic stem cell transplantation for chronic lymphocytic leukemia and Richter's transformation Journal Article
| Authors: | Lahoud, O. B.; Devlin, S. M.; Maloy, M. A.; Roeker, L. E.; Dahi, P. B.; Ponce, D. M.; Gyurkocza, B.; Koehne, G.; Young, J. W.; Castro-Malaspina, H. R.; Barker, J. N.; Papadopoulos, E. B.; Jakubowski, A. A.; Zelenetz, A. D.; Mato, A. R.; Giralt, S. A.; Perales, M. A.; Sauter, C. S. |
| Article Title: | Reduced-intensity conditioning hematopoietic stem cell transplantation for chronic lymphocytic leukemia and Richter's transformation |
| Abstract: | Allogeneic hematopoietic stem cell transplantation (HSCT) may potentially cure patients with chronic lymphocytic leukemia (CLL) and Richter's transformation (CLL-RT) or CLL without RT, but the impact of novel agents on HSCT is unclear. CLL-RT patients have a grave prognosis, and their outcomes after HSCT are uncertain. We conducted a retrospective analysis of all 58 CLL patients, including 23 CLL-RT patients, who underwent reduced intensity conditioning (RIC) HSCT at Memorial Sloan Kettering Cancer Center (New York, NY) between September 2006 and April 2017. With a median follow-up of 68 months (range, 24-147 months), 5-year progression-free survival (PFS) was 40% (95% confidence interval [CI], 28%-56%), and overall survival (OS) was 58% (95% CI, 48%-74%). The 1-year graft-versus-host disease/relapse-free survival (GRFS) was 38% (95% CI, 25%-50%). Patients with CLL-RT and CLL patients without RT had comparable outcomes. In both cohorts, treatment-sensitive response and #3 previous lines of therapy produced superior PFS and OS. Outcomes were agnostic to adverse cytogenetic and molecular features. Novel agents did not have a negative impact on HSCT outcomes. Total body irradiation (TBI)-containing RIC yielded inferior PFS, OS, and GRFS. CLL-RT patients older than age 55 years who had an HSCT Comorbidity Index score of ≥2 demonstrated inferior OS. This study, which is the largest series of RIC-HSCT for patients with CLL-RT, provides evidence supporting RIC-HSCT in early remission courses for patients with CLL-RT and poor-risk CLL patients. TBI-containing RIC should be considered with caution. © 2021 American Society of Hematology. All rights reserved. |
| Journal Title: | Blood Advances |
| Volume: | 5 |
| Issue: | 14 |
| ISSN: | 2473-9529 |
| Publisher: | American Society of Hematology |
| Date Published: | 2021-07-27 |
| Start Page: | 2879 |
| End Page: | 2889 |
| Language: | English |
| DOI: | 10.1182/bloodadvances.2020003726 |
| PROVIDER: | scopus |
| PUBMED: | 34297048 |
| PMCID: | PMC8341347 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 September 2021 -- Source: Scopus |
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