Results of a randomized trial comparing high-dose chemotherapy plus Auto-SCT and R-FC in CLL at diagnosis

M. Magni, M. Di Nicola, C. Patti, R. Scimè, A. Mulè, A. Rambaldi, T. Intermesoli, P. Viero, C. Tarella, A. Gueli, L. Bergui, L. Trentin, A. Barzan, F. Benedetti, A. Ambrosetti, F. Di Raimondo, A. Chiarenza, G. Parvis, A. Billio, I. AttolicoA. Olivieri, M. Montanari, C. Carlo-Stella, P. Matteucci, L. Devizzi, A. Guidetti, S. Viviani, P. Valagussa, A. M. Gianni

Research output: Contribution to journalArticle

Abstract

The importance of early therapy intensification in B-cell CLL (B-CLL) patients remains to be defined. Even though several studies have been published, no randomized trials comparing directly autologous stem cell transplant (ASCT) and the accepted conventional therapy (that is, rituximab, fludarabine and CY; R-FC) have been reported so far. To assess the benefit of a first-line aggressive therapy, we designed a multicenter, randomized, phase 3 trial comparing R-FC and high-dose chemotherapy supported by ASCT in patients under 65 years of age, with stage B(II) or C B-CLL. Primary end point was CR: 96 patients were enrolled (48 in each arm). On an intent-to-treat basis, the CR rates in the ASCT and R-FC arms were 62.5% and 58%, respectively. After 5 years of follow-up, PFS was 60.4% in the ASCT arm and 65.1% in the R-FC arm, time to progression 65.8 and 70.5%, and overall survival 88% vs 88.1%, respectively. Our trial demonstrates, for the first time in a randomized manner, that frontline ASCT does not translate into a survival advantage when compared with benchmark chemoimmunotherapy in B-CLL patients; the possibility of its clinical benefit in certain subgroups remains uncertain.

Original languageEnglish
Pages (from-to)485-491
Number of pages7
JournalBone Marrow Transplantation
Volume49
Issue number4
DOIs
Publication statusPublished - 2014

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Keywords

  • Autologous transplantation
  • B-CLL
  • High-dose chemotherapy

ASJC Scopus subject areas

  • Hematology
  • Transplantation
  • Medicine(all)

Cite this

Magni, M., Nicola, M. D., Patti, C., Scimè, R., Mulè, A., Rambaldi, A., Intermesoli, T., Viero, P., Tarella, C., Gueli, A., Bergui, L., Trentin, L., Barzan, A., Benedetti, F., Ambrosetti, A., Di Raimondo, F., Chiarenza, A., Parvis, G., Billio, A., ... Gianni, A. M. (2014). Results of a randomized trial comparing high-dose chemotherapy plus Auto-SCT and R-FC in CLL at diagnosis. Bone Marrow Transplantation, 49(4), 485-491. https://doi.org/10.1038/bmt.2013.214