CLL: Allogeneic HCT Lengthens Time to Next Therapy
Allogeneic hematopoietic cell transplantation resulted in longer time to next therapy compared with chemotherapy.
Allogeneic hematopoietic cell transplantation (HCT) resulted in longer time to next therapy compared with chemotherapy—particularly chemotherapy administered in the second-, third-, or fourth-line setting, in patients with chronic lymphocytic leukemia (CLL), a study presented at the BMT Tandem Meetings 2016 has shown.1
HCT can achieve durable disease control in CLL, but it is associated with increased morbidity and mortality. HCT remains the only curative option in the era of novel therapy; however, it is unclear in what line of therapy HCT should be considered. Therefore, researchers at Seidman Cancer Center in Cleveland, OH, sought to determine the best timing of HCT by comparing the time to next therapy of HCT with chemotherapy.
For the study, researchers retrospectively analyzed data from 113 treated patients with CLL. Of those, 98 had received chemotherapy and 15 had undergone HCT. The HCT patients were more likely to have received a larger number of lines of chemotherapy than those who did not receive HCT (6 vs 4; P < .001).
Results showed that there was no statistical difference in time to next treatment after HCT and first-line chemotherapy (47 vs 52 months; P = .06), but researchers found that time to next treatment after HCT was longer than after the second (23 months; P < .01), third (11 months; P < .01), and fourth (28 months; P = .03) chemotherapy lines.
In terms of overall survival, there was no significant difference between HCT (53 months) and any of the first 4 lines of chemotherapy (82, 64, 51, and 40 months for lines 1, 2, 3, and 4, respectively). Furthermore, the 1-year cumulative incidence of non-relapse mortality after HCT was 13.3% (95% CI, 3.7 - 48.8), which may be the cause of the lack of survival benefit in heavily pretreated patients.
The findings ultimately demonstrated that HCT can result in long-term disease control in patients who have received multiple lines of chemotherapy.
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“The superior [time to next treatment of HCT vs [chemotherapy] suggests that HCT should remain in the treatment armamentarium for CLL, favoring earlier HCT as an alternative particularly after second remission,” the authors concluded.
- Rondon CS, Whitton T, William B, et al. Allogeneic hematopoietic cell Transplantation (HCT) results in better time to next therapy (TTNT) than chemotherapy (CT) in chronic lymphocytic leukemia (CLL). Poster presented at: BMT Tandem Meetings 2016; February 18-22, 2016; Honolulu, HI.