HLA-IDENTICAL SIBLING BONE-MARROW TRANSPLANTATION IN YOUNGER PATIENTSWITH CHRONIC LYMPHOCYTIC-LEUKEMIA

Objective: To characterize in detail the outcomes of HLA-identical sib ling bone marrow transplantation for chronic lymphocytic leukemia (CLL ) in patients Lounger than 60 years of age. Design: Retrospective coho rt study. Setting: 30 centers for bone marrow transplantation worldwid e, which reported data on outcome of HLA-identical sibling bone marrow transplantation for CLL to the European Group for Blood and Marrow Tr ansplantation or the International Bone Marrow Transplant Registry bet ween 1984 and 1992. Patients: 54 patients diagnosed with CLL (median a ge, 41 years; range, 21 to 58 years). The median interval from diagnos is to transplantation was 37 months (range, 5 to 130 months). At the t ime of transplantation, 3 patients were at Rai stage 0; 10 were at sta ge 1; 10 were at stage 2; 7 were at stage 3; and 22 were at stage 4. I ntervention: Transplant regimens varied. Most patients received high-d ose cyclophosphamide and total body irradiation, followed by infusion of bone marrow from an HLA-identical sibling. After transplantation, i mmune suppression with cyclosporine or methotrexate or both was genera lly used to prevent graft-versus-host disease. Measurements: The prima ry outcome was survival. We also studied hematologic remission, define d as normalization of the leukocyte count, hemoglobin level, and plate let count, and absence of lymphadenopathy and splenomegaly. Results: 3 8 patients (70%) achieved hematologic remission. Twenty-four (44%) rem ain alive a median of 27 months (range, 5 to 80 months) after transpla ntation. Three-year survival probability was 46% (95% CI, 32% to 60%). Three patients who received transplants at Rai stage 0 remain alive 2 1, 32, and 45 months after transplantation. Three-year survival probab ilities were as follows: 68% (CI, 38% to 98%) in 10 patients who recei ved transplants at Rai stage 1, 30% (CI, 2% to 58%) in 10 patients who received transplants at Rai stage 2, 57% (CI, 21% to 93%) in 7 patien ts who received transplants at Rai stage 3, and 34% (CI, 12% to 56%) i n 22 patients who received transplants at Rai stage 4 CLL. Five patien ts (9%) died of progressive leukemia and 25 (46%) of treatment-related complications. Conclusions: Bone marrow transplants from HLA-identica l siblings can result in hematologic remission and survival in persons with CLL, but it is uncertain how these results compare with those of conventional therapies.