CLL: haploidentical allo-BMT with posttransplant cyclophosphamide delivers promising results

  • Paul S & al.
  • Biol Blood Marrow Transplant
  • 12 Nov 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In patients with chronic lymphocytic leukemia (CLL), haploidentical allogeneic blood or marrow transplantation (allo-BMT) with posttransplant cyclophosphamide (PTCy) delivered outcomes consistent with those of patients receiving matched donor allo-BMT, with a low incidence of graft-versus-host disease (GVHD).

Why this matters

  • Matched-sibling donor grafts are available to few patients in this setting.
  • For other patients relying on matched unrelated donors or HLA haploidentical donors, transplant carries a risk for GVHD.

Study design

  • Study to investigate nonmyeloablative (NMA) allo-BMT with PTCy in 64 patients with CLL.
  • NMA comprised fludarabine, cyclophosphamide, and total body irradiation (TBI).
  • Median patient age, 59 (range, 26-74) years.
  • Funding: NIH; National Cancer Institute grants.

Key results

  • 4-year OS: 52% (95% CI, 40%-68%).
  • 4-year PFS: 37% (95% CI, 26%-54%).
  • 6 patients experienced engraftment failure, among whom 5 had ≥20% marrow CLL involvement before transplant.
  • 1-year cumulative incidence (CuI) of grade 2-4 acute GVHD: 27% (95% CI, 15%-38%).
  • 2-year CuI of chronic GVHD: 17% (95% CI, 7%-26%).
  • 3-year CuI of relapse: 36% (95% CI, 23%-49%).
  • 3-year CuI of nonrelapse mortality: 24% (95% CI, 13%-36%).

Limitations

  • Limited sample size.