期刊
LEUKEMIA
卷 27, 期 2, 页码 362-369出版社
NATURE PUBLISHING GROUP
DOI: 10.1038/leu.2012.228
关键词
CLL; RIC; myeloablative; SCT; prognostic model
资金
- NIH [K23 CA115682-01, PO1 HL070149, PO1 CA81538, A129530, P01 CA142106]
- Jock and Bunny Adams Research and Education Endowment
- Ted and Eileen Pasquarello Research Fund
Chronic lymphocytic leukemia (CLL) remains incurable with chemoimmunotherapy, and allogeneic hematopoietic stem cell transplantation (HSCT) offers the potential for cure. We assessed the outcomes of 108 CLL patients undergoing first allogeneic HSCTs, 76 with reduced-intensity (RIC) and 32 with myeloablative conditioning (MAC) between 1998 and 2009 at Dana-Farber Cancer Institute. With median follow-up of 5.9 years in surviving patients, the 5-year overall survival (OS) for the entire cohort is 63% for RIC regimens and 49% for MAC regimens (P=0.18). The risk of death declined significantly starting in 2004, and we found that 5-year OS for HSCT between 2004 and 2009 was 83% for RIC regimens compared with 47% for MAC regimens (P=0.003). For RIC transplantation, we developed a prognostic model based on predictors of progression-free survival (PFS), specifically remission status, lactate dehydrogenase, comorbidity score and lymphocyte count, and found 5-year PFS to be 83% for Score 0, 63% for Score 1, 24% for Score 2 and 6% for Score >= 3 (P<0.0001). We conclude that RIC HSCT for CLL in the current era is associated with excellent long-term PFS and OS, and, as potentially curative therapy, should be considered early in the disease course of relapsed high-risk CLL patients. Leukemia (2013) 27, 362-369; doi:10.1038/leu.2012.228
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