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Reduced intensity conditioning regimens including alkylating chemotherapy do not alter survival outcomes after allogeneic hematopoietic cell transplantation in chronic lymphocytic leukemia compared to low-intensity non-myeloablative conditioning

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  • CLL subcommittee, Chronic Malignancies Working Party
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PURPOSE: The optimal dose intensity for conditioning prior to allogeneic hematopoietic stem cell transplantation (alloHSCT) for chronic lymphocytic leukemia (CLL) is unknown.

METHODS: We retrospectively compared outcomes of patients who received a first alloHCST after non-myeloablative (NMA) and reduced intensity conditioning (RIC). Data of 432 patients with a median age of 55 years were included, of which 86 patients underwent NMA and 346 RIC.

RESULTS: The median follow-up after alloHSCT was 4.3 years. Compared to the RIC group, more NMA patients had purine-analog-sensitive disease, were in complete remission and received matched related donor transplantation. After RIC, the probabilities for 5-year OS, EFS, CIR, and NRM were 46%, 38%, 28%, and 35% and after NMA the respective probabilities were 52%, 43%, 25%, and 32%. In multivariate analysis, remission status prior to conditioning but not RIC versus NMA conditioning had a significant impact on CIR, EFS, and OS.

CONCLUSION: Presumed higher anti-leukemic activity of RIC versus NMA conditioning did not translate into better outcomes after alloHSCT, but better remission status prior to conditioning did. Effective pathway inhibitor-based salvage therapies combined with NMA conditioning might thus represent the most attractive contemporary approach for alloHSCT for patients with CLL.

Original languageEnglish
JournalJournal of Cancer Research and Clinical Oncology
Volume145
Issue number11
Pages (from-to)2823-2834
Number of pages12
ISSN0171-5216
DOIs
Publication statusPublished - Nov 2019

    Research areas

  • Adult, Aged, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Busulfan/administration & dosage, Combined Modality Therapy, Cyclophosphamide/administration & dosage, Female, Follow-Up Studies, Graft vs Host Disease/epidemiology, Hematopoietic Stem Cell Transplantation/mortality, Humans, Incidence, Leukemia, Lymphocytic, Chronic, B-Cell/mortality, Male, Melphalan/administration & dosage, Middle Aged, Prognosis, Remission Induction, Retrospective Studies, Survival Rate, Transplantation Conditioning/mortality, Transplantation, Homologous, Young Adult

ID: 58987082