HEMATOPOIETIC STEM-CELL TRANSPLANTATION IN CHRONIC LYMPHOCYTIC-LEUKEMIA - A REPORT OF 12 PATIENTS FROM A SINGLE INSTITUTION

Background. Stem-cell transplantation is a reasonable therapeutic appr oach for younger patients with high-risk CLL. Patients and methods. Tw elve patients (seven males; median age 47 years, range 29-51) with hig h-risk CLL underwent transplantation (allo, n = 7; auto, n = 5). The c onditioning regimen consisted of cyclophosphamide and total body irrad iation in 11 patients, and BEAC in the remaining one. Minimal residual disease (MRD) was assessed by cytofluorometry and PCR. Results. All 1 1 evaluable patients engrafted. Of the seven allografted patients, two died of treatment-related causes; three patients developed acute GVHD . No transplant-related mortality was observed in autografted patients . After transplantation, 10 of 11 patients evaluable for response achi eved CF, (91%; 95% CI 59%-100%) which was molecular in nine patients ( 82%; 95% CI 48%-98%). One patient in CR but MRD+ relapsed nine months after transplantation and died. Seven patients remain in molecular CR for a median of 16 months (range 1-58). Estimated actuarial survival a nd disease-free survival at two years is 81% (95% CI 43%-100%) and 71% (95% CI 43%-99%), respectively. Relapse risk at two years is 12.5% (9 5% CI 0%-35.5%). Conclusions. Patients with high-risk CLL can achieve longlasting molecular CR after SCT. The role of transplants in CLL man agement deserves investigation in controlled trials.