Rituximab-based allogeneic transplant for chronic lymphocytic leukemia with comparison to historical experience.

Autor: Shadman M; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; University of Washington, Seattle, WA, USA., Maloney DG; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; University of Washington, Seattle, WA, USA., Storer B; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; University of Washington, Seattle, WA, USA., Sandmaier BM; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; University of Washington, Seattle, WA, USA., Chauncey TR; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; University of Washington, Seattle, WA, USA.; VA Puget Sound Healthcare System, Seattle, WA, USA., Smedegaard Andersen N; Department of Haematology, Finsen Center, Rigshospitalet, Copenhagen, Denmark., Niederwieser D; Division of Haematology and Medical Oncology, University of Leipzig, Leipzig, Germany., Shizuru J; Stanford University Medical Center, Stanford, CA, USA., Bruno B; Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy., Pulsipher MA; Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA., Maziarz RT; Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA., Agura ED; Blood & Marrow Transplant Program, Baylor University Medical Center, Dallas, TX, USA., Hari P; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA., Langston AA; Emory University, Winship Cancer Institute, Atlanta, GA, USA., Maris MB; Colorado Blood Cancer Institute, Denver, CO, USA., McSweeney PA; Colorado Blood Cancer Institute, Denver, CO, USA., Storb R; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; University of Washington, Seattle, WA, USA., Sorror ML; Fred Hutchinson Cancer Research Center, Seattle, WA, USA. msorror@fredhutch.org.; University of Washington, Seattle, WA, USA. msorror@fredhutch.org.
Jazyk: angličtina
Zdroj: Bone marrow transplantation [Bone Marrow Transplant] 2020 Jan; Vol. 55 (1), pp. 172-181. Date of Electronic Publication: 2019 Sep 03.
DOI: 10.1038/s41409-019-0660-8
Abstrakt: Relapse of chronic lymphocytic leukemia (CLL) after allogeneic hematopoietic cell transplantation (HCT) remains a clinical challenge. We studied in a phase II trial whether the addition of peri-transplant rituximab would reduce the relapse risk compared with historical controls (n = 157). Patients (n = 55) received fludarabine and low-dose total body irradiation combined with rituximab on days -3, + 10, + 24, + 36. Relapse rate at 3 years was significantly lower among rituximab-treated patients versus controls (17% versus 31%; P = 0.04). Overall survival (OS), progression-free survival (PFS) and nonrelapse mortality (NRM) were statistically similar: (53% versus 50%; P = 0.8), (44% versus 42%; P = 0.63), and (38% versus 28%; P = 0.2), respectively. In multivariate analysis, rituximab treatment was associated with lower relapse rates both in the overall cohort [hazard ratio (HR): 0.34, P = 0.006] and in patients with high-risk cytogenetics (HR: 0.21, P = 0.0003). Patients with no comorbidities who received rituximab conditioning had an OS rate of 100% and 75% at 1 and 3 years, respectively, with no NRM. Peri-transplant rituximab reduced relapse rates regardless of high-risk cytogenetics. HCT is associated with minimal NRM in patients without comorbidities and is a viable option for patients with high-risk CLL. Clinical trial information: NCT00867529.
Databáze: MEDLINE