Allogeneic hematopoietic stem cell transplantation for poor-risk CLL: dissecting immune-modulating strategies for disease eradication and treatment of relapse

Hahn, M., Böttcher, S., Dietrich, S., Hegenbart, U., Rieger, M., Stadtherr, P., Bondong, A., Schulz, R., Ritgen, M., Schmitt, T., Tran, T. H., Goerner, M., Herth, I., Luft, T., Schoenland, S., Witzens-Harig, M., Zenz, T., Kneba, M., Ho, A. D. and Dreger, P. (2015) Allogeneic hematopoietic stem cell transplantation for poor-risk CLL: dissecting immune-modulating strategies for disease eradication and treatment of relapse Bone Marrow Transplantation, 50 (10). pp. 1279-1285.

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Abstract

To elucidate factors contributing to the effectiveness of allogeneic hematopoietic stem cell transplantation (alloHCT) in high-risk CLL, immune interventions, GvHD and clinical outcome of 77 consecutive patients allografted for CLL were analyzed. Immune modulation (immunosuppression tapering, rituximab-augmented donor lymphocyte infusions) was guided by minimal residual disease (MRD) monitoring and commenced at a median of 91 (22-273) days after alloHCT, resulting in a probability of being event free and MRD-negative 1 year after transplant of 57% (84% in those encountering chronic GvHD). Patients who were event free and MRD-negative at the 12-month landmark had a 4-year PFS of 77% and largely remained durably MRD-negative if MRD clearance had occurred subsequent to immune modulation. Three-year overall survival, PFS, relapse incidence and non-relapse mortality of all 77 patients were 69, 57, 26 and 24%, respectively. Survival was not affected by EBMT risk category but by active disease at alloHCT, which could not be overcome by intensification of conditioning. Twenty-three patients who experienced relapse post alloHCT had a survival of 56% at 2 years after CLL recurrence. In conclusion, MRD-guided immune modulation after alloHCT for high-risk CLL can provide durable MRD clearance in more than half of the patients.

Document Type: Article
Additional Information: Times Cited: 0
Research affiliation: OceanRep > The Future Ocean - Cluster of Excellence
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ISSN: 0268-3369
Projects: Future Ocean
Date Deposited: 18 Oct 2016 03:47
Last Modified: 18 Oct 2016 03:47
URI: http://eprints.uni-kiel.de/id/eprint/32502

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