Rituximab-based allogeneic transplant for chronic lymphocytic leukemia with comparison to historical experience.

Abstract:

:Relapse of chronic lymphocytic leukemia (CLL) after allogeneic hematopoietic cell transplantation (HCT) remains a clinical challenge. We studied in a phase II trial whether the addition of peri-transplant rituximab would reduce the relapse risk compared with historical controls (n = 157). Patients (n = 55) received fludarabine and low-dose total body irradiation combined with rituximab on days -3, + 10, + 24, + 36. Relapse rate at 3 years was significantly lower among rituximab-treated patients versus controls (17% versus 31%; P = 0.04). Overall survival (OS), progression-free survival (PFS) and nonrelapse mortality (NRM) were statistically similar: (53% versus 50%; P = 0.8), (44% versus 42%; P = 0.63), and (38% versus 28%; P = 0.2), respectively. In multivariate analysis, rituximab treatment was associated with lower relapse rates both in the overall cohort [hazard ratio (HR): 0.34, P = 0.006] and in patients with high-risk cytogenetics (HR: 0.21, P = 0.0003). Patients with no comorbidities who received rituximab conditioning had an OS rate of 100% and 75% at 1 and 3 years, respectively, with no NRM. Peri-transplant rituximab reduced relapse rates regardless of high-risk cytogenetics. HCT is associated with minimal NRM in patients without comorbidities and is a viable option for patients with high-risk CLL. Clinical trial information: NCT00867529.

journal_name

Bone Marrow Transplant

authors

Shadman M,Maloney DG,Storer B,Sandmaier BM,Chauncey TR,Smedegaard Andersen N,Niederwieser D,Shizuru J,Bruno B,Pulsipher MA,Maziarz RT,Agura ED,Hari P,Langston AA,Maris MB,McSweeney PA,Storb R,Sorror ML

doi

10.1038/s41409-019-0660-8

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

172-181

issue

1

eissn

0268-3369

issn

1476-5365

pii

10.1038/s41409-019-0660-8

journal_volume

55

pub_type

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