The past 5 years have seen the introduction of several new treatments that have significantly extended survival rates for patients with chronic lymphocytic leukemia (CLL). Yet, amid the excitement for these new small-molecule inhibitors, researcher Haesook T. Kim, PhD, was concerned that oncologists were discounting allogeneic hematopoietic cell transplantation (HCT) for patients who had failed other options. “The transplant outcome for CLL patients is actually good, so I wanted the medical community to know that allogeneic transplant is a viable option and can be potentially curative for many CLL patients,” said Dr Kim, principal research scientist at the Dana-Farber Cancer Institute and the Harvard School of Public Health in Boston, Massachusetts.
So Dr Kim set out to see if she could develop a prognostic scoring system that would take into account cytogenetic risk factors and help oncologists determine whether an allogeneic transplant was appropriate for certain patients. “We all know the significance of cytogenetic risk in CLL. However, what is regarded as high cytogenetic risk for CLL patients undergoing transplant was not well defined,” she said.
Dr Kim looked at the Center for International Blood and Marrow Transplant’s database of patients with CLL who underwent reduced-intensity conditioning allogeneic HCT between 2008 and 2014. In a retrospective analysis of 606 patients that was published in June in Clinical Cancer Research, she constructed a model of risk using their remission status, patient fitness, and lymphocyte and white blood cell counts.1
The result was a 4-tier scoring system (low, intermediate, high, and very high) that classified patient risk. For example, using this model for analysis, a patient who was considered to be at low risk had a 58% chance of progression-free survival over 4 years and a 70% chance of overall survival in that same time period. Those numbers were 25% and 38% for the highest-risk patients, respectively. “I wanted to know what were the main driving factors for a good outcome after transplant,” she said.