Low tumor burden is associated with early B-cell reconstitution and is a predictor of favorable outcome after non-myeloablative stem cell transplant for chronic lymphocytic leukemia. Issue 6 (June 2014)

• Record Type: Journal Article
• Authors: Hebenstreit, Karin; Iacobelli, Simona; Leiblein, Sabine; Eisfeld, Ann-Kathrin; Pfrepper, Christian; Heyn, Simone; Vucinic, Vladan; Franke, Georg-Nikolaus; Krahl, Rainer; Fricke, Stephan; Becker, Cornelia; Pönisch, Wolfram; Behre, Gerhard; Niederwieser, Dietger; Lange, Thoralf
• Is Part Of: Leukemia & lymphoma. Volume 55:Issue 6(2014:Jun.)
• Page Start: 1274
• Page End: 1280
• Publication Date: 2014-06
• Subjects: Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.3109/10428194.2013.836598
• Languages: English
• ISSNs: 1042-8194

Abstract

<abstract> <title>Abstract</title> <p>Reconstitution, engraftment kinetics and tumor cell clearance were analyzed after reduced intensity conditioning hematopoietic cell transplant (RIC-HCT) in patients with chronic lymphocytic leukemia (CLL). Patients were transplanted from unrelated (<italic>n</italic> = 40) or related (<italic>n</italic> = 10) donors after fludarabine and 2 Gy total body irradiation followed by cyclosporine and mycophenolate mofetil. The vast majority of patients (96%) engrafted with absolute neutrophil count (ANC) > 0.5 × 10<sup>9</sup>/L at day + 22. CLL cells decreased (median 2%, range 0–69%) within 28 days, but disappeared by day + 180 after HCT. Donor T-cell chimerism increased to > 95% at day 56 and donor B-cell chimerism to 94% at day + 360. Overall survival was 51 ± 8%, incidence of progression 37 ± 7% and non-relapse related mortality (NRM) 30 ± 7% at 4 years. The most common causes of NRM were graft-versus-host disease (GvHD) (14%) and sepsis (6%). Disease status at HCT was significantly associated with early B-cell reconstitution (<italic>p</italic> = 0.04) and with increased risk of relapse/progression in univariate and multivariate analysis (<italic>p</italic> = 0.022). Tumor cells were undetectable by day + 180, although B-cell reconstitution did not occur until 1.5 years after RIC-HCT. The best predictors for progression-free survival (PFS) and overall survival (OS) were complete response (CR) or first partial response (PR1) and the absence of bulky disease at transplant, respectively.</p> </abstract>