Outcome of allogeneic stem cell transplantation for B cell chronic lymphocytic leukemia

The objective of this study was to describe the outcome of allogeneic stem cell transplantation (alloSCT) in a series of patients with B cell chronic lymphocytic leukemia (B-CLL), Twenty-three B-CLL patients were transplanted between 1988 and 1997 using stem cells from a related (n=20) or an unrelat ed donor (n=3), The median age of the patients was 46 years, and the median number of prior chemotherapy regimens received was two. At transplantation , 14 patients had chemorefractory disease and 12 of these were refractory t o fludarabine. The preparative regimens included total body irradiation (TB I) in 22 of the 23 cases. All patients received graft-versus-host disease ( GVHD) prophylaxis with cyclosporine and methotrexate. Twenty patients (87%) achieved a complete remission (CR), The incidence of grade II-IV acute GVH D was 54%. Fourteen (61%) patients are alive and disease-free, including tw o with unrelated donors, at a median of 26 months (range, 9-115 months). Ni ne patients (39%) have died, one of whom had progressive B-CLL, The only fa vorable prognostic factor for failure-free survival (FFS) and overall survi val (OS) after alloSCT was the use of a cyclophosphamide/TBI rather than an etoposide/cyclophosphamide/TBI regimen (P=0.03). The projected 5-year FFS, OS, and relapse rates after alloSCT were 65% (95% CI, 48-88%), 62% (95% CI , 43-88%), and 5% (95%, CI 0-13%), respectively. These findings demonstrate the potential of high-dose therapy and alloSCT for inducing and maintainin g a remission in patients with advanced or chemorefractory B-CLL, The low r elapse rate may be due to an allogeneic graft-versus-leukemia effect.