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Originally published as JCO Early Release 10.1200/JCO.2007.15.4757 on September 15 2008 © 2008 American Society of Clinical Oncology. Five-Year Follow-Up of Patients With Advanced Chronic Lymphocytic Leukemia Treated With Allogeneic Hematopoietic Cell Transplantation After Nonmyeloablative Conditioning
From the Fred Hutchinson Cancer Research Center, University of Washington; and the Veterans Affairs Puget Sound Health Care System, Seattle, WA; Stanford University, Stanford, CA; University of Leipzig, Leipzig, Germany; Oregon Health and Science University, Portland, OR; Baylor University, Baylor, TX; University of Utah, Salt Lake City, UT; University of Colorado, Boulder, CO; Medical College Wisconsin, Milwaukee, WI; University of Torino, Torino, Italy; and Emory University, Atlanta, GA Corresponding author: Mohamed L. Sorror, MD, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D1-100, PO Box 19024, Seattle, WA 98109-1024; e-mail: msorror{at}fhcrc.org Purpose We reported encouraging early results of allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning in 64 patients who had advanced chronic lymphocytic leukemia (CLL). Here, we have extended the follow-up to a median of 5 years and have included data on an additional 18 patients. Patients and Methods Eighty-two patients, age 42 to 72 years, who had fludarabine-refractory CLL were conditioned with 2 Gy total-body irradiation alone or combined with fludarabine followed by HCT from related (n = 52) or unrelated (n = 30) donors.
Results Complete remission (CR) and partial remission were achieved in 55% and 15% of patients, respectively. Higher CR rates were noted after unrelated HCT (67% v 48%). The 5-year incidences of nonrelapse mortality (NRM), progression/relapse, overall survival, and progression-free survival were 23%, 38%, 50%, and 39%, respectively. Among 25 patients initially reported in CR, 8% relapsed and 8% died as a result of NRM, whereas 84% have remained alive and in CR. Among 14 responding patients who were tested and who had molecular eradication of their disease, two died as a result of NRM, two relapsed, and 10 have remained negative. At 5 years, 76% of living patients were entirely well, whereas 24% continued to receive immunosuppression for chronic graft-versus-host disease; the median performance status in each group was 100% and 90%, respectively. Lymphadenopathy Conclusion Nonmyeloablative HCT resulted in a median survival of 5 years for patients who had fludarabine-refractory CLL with sustained remissions and in the continued resolution of chronic graft-versus-host disease in surviving patients. published online ahead of print at www.jco.org on September 15, 2008. Supported by Grants No. CA78902, CA18029, and CA15704 from the National Institutes of Health, Bethesda, MD. (M.S); in part by the Paros Family Fund (M.L.S.); and by a grant from Ministero dell'Istruzione, dell'Università, della Ricerca, Italy (B.B.). Presented in part at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA, and at the Tandem Bone Marrow Transplantation Meeting, February 8-12, 2007, Keystone, CO. Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.
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Copyright © 2008 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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5 cm, but not cytogenetic abnormalities at HCT, predicted relapse. In a risk-stratification model, patients who had lymphadenopathy less than 5 cm and no comorbidities had a 5-year OS of 71%. 
