Relationship to Donor Affects Outcomes Among Patients With CLL Undergoing alloHCT

Relationship to donor, age, exon deletion, and previous treatments are factors likely to determine outcomes among patients with chronic lymphocytic leukemia (CLL) undergoing allogeneic hematopoietic stem cell transplantation (alloHCT), according to a study presented at the XVII International Workshop on Chronic Lymphocytic Leukemia (iwCLL).¹

Although kinase inhibitors and BCL2 inhibitors can induce long-term responses among patients with CLL, those with refractory disease have few options. AlloHCT can be effective in this setting, though there is a risk of non-relapse mortality.

For this study, researchers evaluated disease and patient factors likely to influence outcomes among those younger than 50 years undergoing alloHCT.

The authors developed 2 sets of characteristics: 1 for “good-risk patients,” and the second for “poor-risk patients,” according to Michel van Gelder, MD, PhD, of the Maastricht University Medical Center in the Netherlands, who presented this research.

Being a “good-risk patient” implied a low likelihood of non-relapse mortality and a high likelihood of being progression-free for 8 years.

“Good-risk” patients were 46 years old, had del17p and/or del11q, had not previously undergone autologous HCT, and had an HLA-matched sibling donor.

The relationship to the donor was a strong predictor of outcomes: the risk of non-relapse mortality was highest among those with an HLA-matched unrelated donor or a partially HLA-matched unrelated donor.

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Patients who were not in remission after alloHCT had a worse 8-year progression-free survival.

The authors concluded that “for patients who are refractory on several or all of the new drugs, alloHCT should always be considered as a valuable chance for long-term survival.”

Reference

1. van Gelder M, Ziagkos D, de Wreede L, et al. Allogeneic hematopoietic stem cell transplantation using HLA compatible donors in younger high cytogenetic risk CLL patients results in very high long-term progression-free survival and may therefore favorably compete with sequential targeted therapy. Paper presented at: XVII International Workshop on Chronic Lymphocytic Leukemia; May 12-15, 2017; New York, NY.