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−)

Clinical Cancer Research - Tập 11 Số 21 - Trang 7757-7763 - 2005
Dolores Caballero1, José A. García‐Marco2, Rodrigo Martino3, Victoria Mateos1, Josep‐María Ribera4, José Sarrá5, Ángel León6, Guillermo Sanz7, Javier de la Serna8, Rafael Cabrera2, Douglas F. Easton1, Jorge Sierra3, Jesús F. San Miguel1
11Hospital Clínico Universitario de Salamanca, Salamanca, Spain;
22Hospital Puerta de Hierro,
34Hospital de la Santa Creu i Sant Pau,
46Hospital Germans Trias i Pujol de Badalona, Badalona, Spain;
55Institut Catalá d'Oncologia, Barcelona, Spain;
67Hospital de la Seguridad Social de Jerez de la Frontera, Andalusia, Spain; and
78Hospital La Fe de Valencia, Valencia, Spain
83Hospital 12 de Octubre de Madrid, Madrid, Spain;

Tóm tắt

Abstract 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 (IgVH) status; 8 of 25 patients (32%) had 11q−, with four of them also displaying unmutated IgVH; 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 days 100 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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Tài liệu tham khảo

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Clinical Cancer Research

Tập 11 Số 21

7757-7763

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