Outcomes of human leukocyte antigen-matched sibling donor hematopoietic cell transplantation in chronic lymphocytic leukemia: Myeloablative versus reduced-intensity conditioning regimens

Ronald M. Sobecks, Jose F. Leis, Robert Peter Gale, Kwang Woo Ahn, Xiaochun Zhu, Mitchell Sabloff, Marcos de Lima, Jennifer R. Brown, Yoshihiro Inamoto, Gregory A. Hale, Mahmoud D. Aljurf, Rammurti T. Kamble, Jack W. Hsu, Steven Z. Pavletic, Baldeep Wirk, Matthew D. Seftel, Ian D. Lewis, Edwin P. Alyea, Jorge Cortes, Matt E. KalaycioRichard T. Maziarz, Wael Saber

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Allogeneic hematopoietic cell transplantation (HCT) can cure some chronic lymphocytic leukemia (CLL) subjects. This study compared outcomes of myeloablative (MA) and reduced-intensity conditioning (RIC) transplants from HLA-matched sibling donors (MSD) for CLL. From 1995 to 2007, information regarding 297 CLL subjects was reported to the Center of International Blood and Marrow Transplant Research; of these, 163 underwent MA and 134 underwent RIC MSD HCT. The MA subjects underwent transplantation less often after 2000 and less commonly received antithymocyte globulin (4% versus 13%, P= .004) or prior antibody therapy (14% versus 53%; P < .001). RIC was associated with a greater likelihood of platelet recovery and less grade 2 to 4 acute graft-versus-host disease compared with MA conditioning. One- and 5-year treatment-related mortality (TRM) were 24% (95% confidence intervals [CI], 16% to 33%) versus 37% (95% CI, 30% to 45%; P= .023), and 40% (95% CI, 29% to 51%) versus 54% (95% CI, 46% to 62%; P= .036), respectively, and the relapse/progression rates at 1 and 5years were 21% (95% CI, 14% to 29%) versus 10% (95% CI, 6% to 15%; P=020), and 35% (95% CI, 26% to 46%) versus 17% (95% CI, 12% to 24%; P= .003), respectively. MA conditioning was associated with better progression-free (PFS) (relative risk, .60; 95% CI, .37 to .97; P= .038) and 3-year survival in transplantations before 2001, but for subsequent years, RIC was associated with better PFS and survival (relative risk, 1.49 [95% CI, .92 to 2.42]; P= .10; and relative risk, 1.86 [95% CI, 1.11 to 3.13]; P=019). Pretransplantation disease status was the most important predictor of relapse (P= .003) and PFS (P= .0007) for both forms of transplantation conditioning. MA and RIC MSD transplantations are effective for CLL. Future strategies to decrease TRM and reduce relapses are warranted.

Original languageEnglish (US)
Pages (from-to)1390-1398
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number9
DOIs
StatePublished - Jan 1 2014

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Cell Transplantation
B-Cell Chronic Lymphocytic Leukemia
HLA Antigens
Confidence Intervals
Transplantation
Recurrence
Transplantation Conditioning
Transplants
Antilymphocyte Serum
Mortality
Graft vs Host Disease
Therapeutics
Blood Platelets
Bone Marrow
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Sobecks, Ronald M. ; Leis, Jose F. ; Gale, Robert Peter ; Ahn, Kwang Woo ; Zhu, Xiaochun ; Sabloff, Mitchell ; de Lima, Marcos ; Brown, Jennifer R. ; Inamoto, Yoshihiro ; Hale, Gregory A. ; Aljurf, Mahmoud D. ; Kamble, Rammurti T. ; Hsu, Jack W. ; Pavletic, Steven Z. ; Wirk, Baldeep ; Seftel, Matthew D. ; Lewis, Ian D. ; Alyea, Edwin P. ; Cortes, Jorge ; Kalaycio, Matt E. ; Maziarz, Richard T. ; Saber, Wael. / Outcomes of human leukocyte antigen-matched sibling donor hematopoietic cell transplantation in chronic lymphocytic leukemia : Myeloablative versus reduced-intensity conditioning regimens. In: Biology of Blood and Marrow Transplantation. 2014 ; Vol. 20, No. 9. pp. 1390-1398.
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title = "Outcomes of human leukocyte antigen-matched sibling donor hematopoietic cell transplantation in chronic lymphocytic leukemia: Myeloablative versus reduced-intensity conditioning regimens",
abstract = "Allogeneic hematopoietic cell transplantation (HCT) can cure some chronic lymphocytic leukemia (CLL) subjects. This study compared outcomes of myeloablative (MA) and reduced-intensity conditioning (RIC) transplants from HLA-matched sibling donors (MSD) for CLL. From 1995 to 2007, information regarding 297 CLL subjects was reported to the Center of International Blood and Marrow Transplant Research; of these, 163 underwent MA and 134 underwent RIC MSD HCT. The MA subjects underwent transplantation less often after 2000 and less commonly received antithymocyte globulin (4{\%} versus 13{\%}, P= .004) or prior antibody therapy (14{\%} versus 53{\%}; P < .001). RIC was associated with a greater likelihood of platelet recovery and less grade 2 to 4 acute graft-versus-host disease compared with MA conditioning. One- and 5-year treatment-related mortality (TRM) were 24{\%} (95{\%} confidence intervals [CI], 16{\%} to 33{\%}) versus 37{\%} (95{\%} CI, 30{\%} to 45{\%}; P= .023), and 40{\%} (95{\%} CI, 29{\%} to 51{\%}) versus 54{\%} (95{\%} CI, 46{\%} to 62{\%}; P= .036), respectively, and the relapse/progression rates at 1 and 5years were 21{\%} (95{\%} CI, 14{\%} to 29{\%}) versus 10{\%} (95{\%} CI, 6{\%} to 15{\%}; P=020), and 35{\%} (95{\%} CI, 26{\%} to 46{\%}) versus 17{\%} (95{\%} CI, 12{\%} to 24{\%}; P= .003), respectively. MA conditioning was associated with better progression-free (PFS) (relative risk, .60; 95{\%} CI, .37 to .97; P= .038) and 3-year survival in transplantations before 2001, but for subsequent years, RIC was associated with better PFS and survival (relative risk, 1.49 [95{\%} CI, .92 to 2.42]; P= .10; and relative risk, 1.86 [95{\%} CI, 1.11 to 3.13]; P=019). Pretransplantation disease status was the most important predictor of relapse (P= .003) and PFS (P= .0007) for both forms of transplantation conditioning. MA and RIC MSD transplantations are effective for CLL. Future strategies to decrease TRM and reduce relapses are warranted.",
author = "Sobecks, {Ronald M.} and Leis, {Jose F.} and Gale, {Robert Peter} and Ahn, {Kwang Woo} and Xiaochun Zhu and Mitchell Sabloff and {de Lima}, Marcos and Brown, {Jennifer R.} and Yoshihiro Inamoto and Hale, {Gregory A.} and Aljurf, {Mahmoud D.} and Kamble, {Rammurti T.} and Hsu, {Jack W.} and Pavletic, {Steven Z.} and Baldeep Wirk and Seftel, {Matthew D.} and Lewis, {Ian D.} and Alyea, {Edwin P.} and Jorge Cortes and Kalaycio, {Matt E.} and Maziarz, {Richard T.} and Wael Saber",
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language = "English (US)",
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Sobecks, RM, Leis, JF, Gale, RP, Ahn, KW, Zhu, X, Sabloff, M, de Lima, M, Brown, JR, Inamoto, Y, Hale, GA, Aljurf, MD, Kamble, RT, Hsu, JW, Pavletic, SZ, Wirk, B, Seftel, MD, Lewis, ID, Alyea, EP, Cortes, J, Kalaycio, ME, Maziarz, RT & Saber, W 2014, 'Outcomes of human leukocyte antigen-matched sibling donor hematopoietic cell transplantation in chronic lymphocytic leukemia: Myeloablative versus reduced-intensity conditioning regimens', Biology of Blood and Marrow Transplantation, vol. 20, no. 9, pp. 1390-1398. https://doi.org/10.1016/j.bbmt.2014.05.020

Outcomes of human leukocyte antigen-matched sibling donor hematopoietic cell transplantation in chronic lymphocytic leukemia : Myeloablative versus reduced-intensity conditioning regimens. / Sobecks, Ronald M.; Leis, Jose F.; Gale, Robert Peter; Ahn, Kwang Woo; Zhu, Xiaochun; Sabloff, Mitchell; de Lima, Marcos; Brown, Jennifer R.; Inamoto, Yoshihiro; Hale, Gregory A.; Aljurf, Mahmoud D.; Kamble, Rammurti T.; Hsu, Jack W.; Pavletic, Steven Z.; Wirk, Baldeep; Seftel, Matthew D.; Lewis, Ian D.; Alyea, Edwin P.; Cortes, Jorge; Kalaycio, Matt E.; Maziarz, Richard T.; Saber, Wael.

In: Biology of Blood and Marrow Transplantation, Vol. 20, No. 9, 01.01.2014, p. 1390-1398.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of human leukocyte antigen-matched sibling donor hematopoietic cell transplantation in chronic lymphocytic leukemia

T2 - Myeloablative versus reduced-intensity conditioning regimens

AU - Sobecks, Ronald M.

AU - Leis, Jose F.

AU - Gale, Robert Peter

AU - Ahn, Kwang Woo

AU - Zhu, Xiaochun

AU - Sabloff, Mitchell

AU - de Lima, Marcos

AU - Brown, Jennifer R.

AU - Inamoto, Yoshihiro

AU - Hale, Gregory A.

AU - Aljurf, Mahmoud D.

AU - Kamble, Rammurti T.

AU - Hsu, Jack W.

AU - Pavletic, Steven Z.

AU - Wirk, Baldeep

AU - Seftel, Matthew D.

AU - Lewis, Ian D.

AU - Alyea, Edwin P.

AU - Cortes, Jorge

AU - Kalaycio, Matt E.

AU - Maziarz, Richard T.

AU - Saber, Wael

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Allogeneic hematopoietic cell transplantation (HCT) can cure some chronic lymphocytic leukemia (CLL) subjects. This study compared outcomes of myeloablative (MA) and reduced-intensity conditioning (RIC) transplants from HLA-matched sibling donors (MSD) for CLL. From 1995 to 2007, information regarding 297 CLL subjects was reported to the Center of International Blood and Marrow Transplant Research; of these, 163 underwent MA and 134 underwent RIC MSD HCT. The MA subjects underwent transplantation less often after 2000 and less commonly received antithymocyte globulin (4% versus 13%, P= .004) or prior antibody therapy (14% versus 53%; P < .001). RIC was associated with a greater likelihood of platelet recovery and less grade 2 to 4 acute graft-versus-host disease compared with MA conditioning. One- and 5-year treatment-related mortality (TRM) were 24% (95% confidence intervals [CI], 16% to 33%) versus 37% (95% CI, 30% to 45%; P= .023), and 40% (95% CI, 29% to 51%) versus 54% (95% CI, 46% to 62%; P= .036), respectively, and the relapse/progression rates at 1 and 5years were 21% (95% CI, 14% to 29%) versus 10% (95% CI, 6% to 15%; P=020), and 35% (95% CI, 26% to 46%) versus 17% (95% CI, 12% to 24%; P= .003), respectively. MA conditioning was associated with better progression-free (PFS) (relative risk, .60; 95% CI, .37 to .97; P= .038) and 3-year survival in transplantations before 2001, but for subsequent years, RIC was associated with better PFS and survival (relative risk, 1.49 [95% CI, .92 to 2.42]; P= .10; and relative risk, 1.86 [95% CI, 1.11 to 3.13]; P=019). Pretransplantation disease status was the most important predictor of relapse (P= .003) and PFS (P= .0007) for both forms of transplantation conditioning. MA and RIC MSD transplantations are effective for CLL. Future strategies to decrease TRM and reduce relapses are warranted.

AB - Allogeneic hematopoietic cell transplantation (HCT) can cure some chronic lymphocytic leukemia (CLL) subjects. This study compared outcomes of myeloablative (MA) and reduced-intensity conditioning (RIC) transplants from HLA-matched sibling donors (MSD) for CLL. From 1995 to 2007, information regarding 297 CLL subjects was reported to the Center of International Blood and Marrow Transplant Research; of these, 163 underwent MA and 134 underwent RIC MSD HCT. The MA subjects underwent transplantation less often after 2000 and less commonly received antithymocyte globulin (4% versus 13%, P= .004) or prior antibody therapy (14% versus 53%; P < .001). RIC was associated with a greater likelihood of platelet recovery and less grade 2 to 4 acute graft-versus-host disease compared with MA conditioning. One- and 5-year treatment-related mortality (TRM) were 24% (95% confidence intervals [CI], 16% to 33%) versus 37% (95% CI, 30% to 45%; P= .023), and 40% (95% CI, 29% to 51%) versus 54% (95% CI, 46% to 62%; P= .036), respectively, and the relapse/progression rates at 1 and 5years were 21% (95% CI, 14% to 29%) versus 10% (95% CI, 6% to 15%; P=020), and 35% (95% CI, 26% to 46%) versus 17% (95% CI, 12% to 24%; P= .003), respectively. MA conditioning was associated with better progression-free (PFS) (relative risk, .60; 95% CI, .37 to .97; P= .038) and 3-year survival in transplantations before 2001, but for subsequent years, RIC was associated with better PFS and survival (relative risk, 1.49 [95% CI, .92 to 2.42]; P= .10; and relative risk, 1.86 [95% CI, 1.11 to 3.13]; P=019). Pretransplantation disease status was the most important predictor of relapse (P= .003) and PFS (P= .0007) for both forms of transplantation conditioning. MA and RIC MSD transplantations are effective for CLL. Future strategies to decrease TRM and reduce relapses are warranted.

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