Results of the MRC pilot study show autografting for younger patients with chronic lymphocytic leukemia is safe and achieves a high percentage of molecular responses.

Abstract

We have assessed autologous stem cell transplantation after treatment with fludarabine in previously untreated patients with chronic lymphocytic leukemia (CLL). This study is the first to enroll previously untreated patients and follow them prospectively. The initial response rate to fludarabine was 82% (94 of 115 patients). Stem cell mobilization was attempted in 88 patients and was successful in 59 (67%). Overall 65 of 115 patients (56%) entered into the study proceeded to autologous transplantation. The early transplant-related mortality rate was 1.5% (1 of 65 patients). The number of patients in complete remission after transplantation increased from 37% (24 of 65) to 74% (48 of 65), and 26 of 41 patients (63%) who were not in complete remission at the time of their transplantation achieved a complete remission after transplantation. The 5-year overall and disease-free survival rates from transplantation were 77.5% (CI, 57.2%-97.8%) and 51.5% (CI, 33.2%-69.8%), respectively. None of the variables examined at study entry were found to be predictors of either overall or disease-free survival. Sixteen of 20 evaluable patients achieved a molecular remission on a polymerase chain reaction (PCR) for immunoglobulin heavy-chain gene rearrangements in the first 6 months following transplantation. Detectable molecular disease by PCR was highly predictive of disease recurrence. It is of concern that 5 of 65 (8%) patients developed posttransplant acute myeloid leukemia/myelodysplastic syndrome.

• Authors: Donald W Milligan, Savio Fernandes, Ranjit Dasgupta, Faith E Davies, Estella Matutes, Christopher D Fegan, Christopher McConkey, J Anthony Child, David Cunningham, Gareth J Morgan, Daniel Catovsky, National Cancer Research Institute Haematological Studies Group
• Journal: Blood (Blood) Vol. 105 Issue 1 Pg. 397-404 (Jan 01 2005) ISSN: 0006-4971 [Print] United States
• PMID: 15117764 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Topics

• Adult
• Aging (physiology)
• Disease Progression
• Female
• Follow-Up Studies
• Hematopoietic Stem Cell Mobilization
• Humans
• Leukemia, Lymphocytic, Chronic, B-Cell (complications, immunology, pathology, surgery)
• Male
• Middle Aged
• Myelodysplastic Syndromes (complications)
• Neoplasm, Residual (pathology)
• Pilot Projects
• Survival Rate
• Transplantation, Autologous (adverse effects, immunology)