Allogeneic transplant with reduced intensity conditioning regimens may overcome the poor prognosis of B-cell chronic lymphocytic leukemia with unmutated immunoglobulin variable heavy-chain gene and chromosomal abnormalities (11q- and 17p-)

被引:93
作者
Caballero, D
García-Macro, JA
Martino, R
Mateos, V
Ribera, JM
Sarrá, J
León, A
Sanz, G
la Serna, JC
Cabrera, R
González, M
Sierra, J
San Miguel, J
机构
[1] Hosp Clin Univ Salamanca, Serv Hematol, Salamanca 37007, Spain
[2] Hosp Puerta Hierro, Madrid, Spain
[3] Hosp 12 Octubre, E-28041 Madrid, Spain
[4] Hosp Santa Creu & Sant Pau, Barcelona, Spain
[5] Inst Catala Oncol, Barcelona, Spain
[6] Hosp Badalona Germans Trias & Pujol, Badalona, Spain
[7] Hosp Segur Social Frontera, Andalucia, Spain
[8] Hosp La Fe Valencia, Valencia, Spain
关键词
D O I
10.1158/1078-0432.CCR-05-0941
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To evaluate the efficacy of reduced intensity conditioning (RIC) allogeneic transplant in 30 patients with poor-prognosis chronic lymphocytic leukemia (CLL) and/or high-risk molecular/cytogenetic characteristics. Experimental Design: Eighty-three percent of patients had active disease at the moment of transplant. That is, 14 of the 23 patients analyzed (60%) had unmutated immunoglobulin variable heavy-chain gene (IgV(H)) status; 8 of 25 patients (32%) had 11q-, with four of them also displaying unmutated IgV(H); and six (24%) had 17p- (five were also unmutated). Results: After a median follow-up of 47.3 months, all 22 patients alive are disease free; overall survival and event-free survival (EFS) at 6 years were 70% and 72%, respectively. According to molecular/cytogenetic characteristics, overall survival and EFS for unmutated CLL and/or with 11q- aberration (n = 13) were 90% and 92%, respectively, not significantly different to those with normal in situ hybridization, 13q- and +12, or mutated CLL (n = 7). All six patients with 17p deletion were transplanted with active disease, including three with refractory disease; all except one reached complete remission after the transplant and two are alive and disease free. Nonrelapse mortality (NRM) was 20%; more than two lines before transplant is an independent prognostic factor for NRM (P = 0,02), EFS (P = 0.02), and overall survival (P = 0.01). Patients older than 55 years have a higher risk of NRM (hazard ratio, 12.8; 95% confidence interval, 1.5-111). Minimal residual disease was monitored by multiparametric flow cytometry in 21 patients. Clearance of CD79/CD5/CD19/CD23 cells in bone marrow was achieved in 68% and 94% of the patients at days100 and 360, respectively. Conclusion: According to these results, RIC allogeneic transplant could overcome the adverse prognosis of patients with unmutated CLL as well as those with 11q- or 17p-.
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页码:7757 / 7763
页数:7
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