Kronik Lenfositik Lösemi’de Allojeneik Kök Hücre Nakli Deneyimi
Abstract
Objective: Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. In patients with poor prognosis, allogeneic stem cell transplantation (ASCT)treatment is an alternative. ASCT indications in CLL: Patients with refractory disease or early relapse (shorter than 12 months) after treatment with purine analogues, relapse within 24 months after achieving response with purine analogues/autologous stem cell transplantation or in patients with p53 anomalies. However, the indications have been revised after novel therapies reached successful results in relapsed/refractory setting. In this study, we aimed to evaluate our CLL patients who underwent ASCT.
Materials and Methods: Seven high-risk patients with CLL who were diagnosed at Ankara University School of Medicine Department of Hematology between 2007-2015and subsequently underwent ASCT at our Bone Marrow Transplantation Unit were evaluated retrospectively.
Results: In post-transplant disease evaluation, 4/7 patients (57%) achieved complete remission and 3/7 patients (43%) did not respond. Acute graft versus host disease was detected in 2/7 (29%) patients while 3/7 (43%) patients were diagnosed with chronic graft versus host disease. Overall survival was 69 months (range, 19-121 months).
Conclusion: Sustained response rates can be achieved with ASCT in high-risk CLL patients in long-term.
Keywords
Allogeneic Stem Cell Transplantation, Chronic Lymphocytic Leukemia, Leukemia
References
- 1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program (SEER). Cancer Statistics Review: 1975-2010, November 21, 2013.
- 2. Bazargan A, Tam CS, Keating MJ. Predicting survival in chronic lymphocytic leukemia. Expert Rev Anticancer Ther. 2012; 12:393–403.
- 3. Chao MP. Treatment challenges in the management of relapsed or refractory nonHodgkin’s lymphoma - novel and emerging therapies. Cancer Manag Res. 2013;5:251-269.
- 4. Byrd JC, Brown JR, O’Brien S, et al. Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. N Engl J Med. 2014;371:213-223.
- 5. Furman RR, Sharman JP, Coutre SE, et al. Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. N Engl J Med. 2014; 370:997-1007.
- 6. Roberts AW, Davids MS, Pagel JM, et al. Targeting BCL2 with venetoclax in relapsed chronic lymphocytic leukemia. N Engl J Med. 2016;374:311-322
- 7. Stilgenbauer S, Zenz T. Understanding and managing ultra high-risk chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program. 2010;2010:481-488.
- 8. Kharfan-Dabaja MA, Kumar A, Hamadani M, et al. Clinical practice recommendations for use of allogeneic hematopoietic cell transplantation in chroniclymphocytic leukemia on behalf of the guidelines Committee of the American Society for blood and marrow transplantation. Biol Blood Marrow Transplant. 2016; 22:2117-2125.
- 9. Sorror ML, Storer BE, Sandmaier BM, et al. Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. J Clin Oncol 2008; 26:4912-4920.
- 10. Gratwohl A, Stern M, Brand R, et al. Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Cancer. 2009;115: 4715-4726.