High incidence of chronic graft-versus-host disease after myeloablative allogeneic stem cell transplantation for chronic lymphocytic leukemia in Sweden: graft-versus-leukemia effect protects against relapse

Research output: Contribution to journalArticle

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a potentially curative treatment option for eligible patients with chronic lymphocytic leukemia (CLL). However, it is known that cure of CLL is only possible if a graft-versus-leukemia effect is present. Between 1994 and 2007, 48 adults underwent allo-SCT for poor-risk CLL in Sweden. Of these, ten (21%) patients aged 24-53 years (median: 46 years) received myeloablative conditioning (MAC), based on TBI and cyclophosphamide. All MAC patients had refractory, poorly controlled CLL before allo-SCT (partial remission in 9/10 patients and progressive disease in one). The cumulative incidence of acute graft-versus-host disease (GVHD) grades II-IV was 30%. Nine patients developed chronic GVHD; extensive in four. Rates of nonrelapse mortality at 1, 3 and 10 years were 0, 10 and 20%, respectively. Two patients relapsed 36 and 53 months after transplantation. Six patients were still alive after a median follow-up time of 11.5 years (range 5.9-13.7). The probabilities of relapse-free and overall survival from 1, 3 and 5 years after transplantation were 100, 90 and 70%, and 100, 90 and 80%, respectively. Nevertheless, our analysis of long-term outcome after MAC allo-SCT for CLL suggests that younger patients with poorly controlled CLL may benefit from MAC allo-SCT.

Details

Authors
  • Maciej Machaczka
  • Jan-Erik Johansson
  • Mats Remberger
  • Helene Hallböök
  • Vladimir Lj Lazarevic
  • Björn Engelbrekt Wahlin
  • Hamdy Omar
  • Anders Wahlin
  • Gunnar Juliusson
  • Eva Kimby
  • Hans Hägglund
Organisations
External organisations
  • Karolinska Institutet
  • Sahlgrenska University Hospital
  • Uppsala University Hospital
  • Skåne University Hospital
  • Umeå University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Hematology

Keywords

  • Adult, Disease Progression, Female, Graft vs Host Disease, Graft vs Leukemia Effect, Hematopoietic Stem Cell Transplantation, Humans, Kaplan-Meier Estimate, Leukemia, Lymphocytic, Chronic, B-Cell, Male, Middle Aged, Sweden, Transplantation, Homologous, Young Adult
Original languageEnglish
Pages (from-to)762
JournalMedical Oncology
Volume30
Issue number4
Publication statusPublished - 2013 Dec
Publication categoryResearch
Peer-reviewedYes