Refractory and 17p-deleted chronic lymphocytic leukemia: improving survival with pathway inhibitors and allogeneic stem cell transplantation: Biology of Blood and Marrow Transplantation

L. Farina, F. Barretta, L. Scarfò, B. Bruno, F. Patriarca, A.M. Frustaci, M. Coscia, C. Salvetti, G. Quaresmini, R. Fanin, F. Onida, M. Magagnoli, F. Zallio, D. Vallisa, G. Reda, A. Ferrario, P. Corradini, M. Montillo

Research output: Contribution to journalArticlepeer-review

Abstract

Refractory/early relapsed and 17p deletion/p53 mutation (del(17p)/TP53mut)-positive chronic lymphocytic leukemia (CLL) has been conventionally considered a high-risk disease, potentially eligible for treatment with allogeneic stem cell transplantation (alloSCT). In this multicenter retrospective analysis of 157 patients, we compared the outcomes of patients with high-risk CLL treated with alloSCT, a B-cell receptor pathway inhibitor (BCRi), and both. Seventy-one patients were treated with BCRis, 67 patients underwent reduced-intensity conditioning alloSCT, and 19 received alloSCT with a BCRi before and/or after transplantation. Inverse probability of treatment weighting analyses were performed to compare the alloSCT and no-alloSCT groups; in the 2 groups, 5-year OS, PFS, and cumulative incidence of nonrelapse mortality (NRM) and relapse were 40% versus 60% (P = .096), 34% versus 17% (P = .638), 28% versus 5% (P = .016), and 38% versus 83% (P = .005), respectively. Patients treated with alloSCT plus BCRi had a 3-year OS of 83%. The 3-year OS and NRM by year of alloSCT, including patients treated with BCRi, were 53% and 17% in 2000 to 2007, 55% and 30% in 2008 to 2012, and 72% and 18% in 2013 to 2018. In conclusion, the combination of pathway inhibitors and alloSCT is feasible and may further improve the outcome of high-risk CLL patients. © 2020 American Society for Transplantation and Cellular Therapy
Original languageEnglish
Pages (from-to)e256-e262
JournalBiol. Blood Marrow Transplant.
Volume26
Issue number10
DOIs
Publication statusPublished - 2020

Keywords

  • Allogeneic transplantation
  • BCR inhibitor
  • Chronic lymphocytic leukemia
  • B lymphocyte receptor
  • ibrutinib
  • idelalisib
  • protein p53
  • rituximab
  • venetoclax
  • acute graft versus host disease
  • adult
  • allogeneic stem cell transplantation
  • Article
  • cancer mortality
  • cancer prognosis
  • cancer survival
  • chromosome 17p
  • chromosome deletion
  • chronic graft versus host disease
  • chronic lymphatic leukemia
  • clinical assessment
  • comparative study
  • controlled study
  • drug withdrawal
  • female
  • haploidentical transplantation
  • high risk patient
  • human
  • intermediate risk patient
  • low risk patient
  • major clinical study
  • male
  • mortality rate
  • outcome assessment
  • overall survival
  • progression free survival
  • reduced intensity conditioning
  • relapse
  • retrospective study
  • risk assessment
  • risk factor

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