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Baseline Characteristics Predicting Very Good Outcome of Allogeneic Hematopoietic Cell Transplantation in Young Patients With High Cytogenetic Risk Chronic Lymphocytic Leukemia - A Retrospective Analysis From the Chronic Malignancies Working Party of the EBMT
M. van Gelder, D. Ziagkos, L. de Wreede, A. van Biezen, P. Dreger, M. Gramatzki, M. Stelljes, NS. Andersen, N. Schaap, A. Vitek, D. Beelen, V. Lindström, J. Finke, J. Passweg, M. Eder, M. Machaczka, J. Delgado, W. Krüger, L. Raida, G. Socié, P....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články
- MeSH
- chromozomální aberace * MeSH
- chronická lymfatická leukemie diagnóza genetika mortalita terapie MeSH
- dárci tkání MeSH
- dospělí MeSH
- HLA antigeny MeSH
- homologní transplantace MeSH
- Kaplanův-Meierův odhad MeSH
- lidé středního věku MeSH
- lidé MeSH
- příprava pacienta k transplantaci škodlivé účinky metody MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- transplantace hematopoetických kmenových buněk * škodlivé účinky metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Patients with genetically high-risk relapsed/refractory chronic lymphocytic leukemia have shorter median progression-free survival (PFS) with kinase- and BCL2-inhibitors (KI, BCL2i). Allogeneic hematopoietic stem cell transplantation (alloHCT) may result in sustained PFS, especially in younger patients because of its age-dependent non-relapse mortality (NRM) risk, but outcome data are lacking for this population. PATIENTS AND METHODS: Risk factors for 2-year NRM and 8-year PFS were identified in patients < 50 years in an updated European Society for Blood and Marrow Transplantation registry cohort (n = 197; median follow-up, 90.4 months) by Cox regression modeling, and predicted probabilities of NRM and PFS of 2 reference patients with favorable or unfavorable characteristics were plotted. RESULTS: Predictors for poor 8-year PFS were no remission at the time of alloHCT (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.1-2.5) and partially human leukocyte antigen (HLA)-mismatched unrelated donor (HR, 2.8; 95% CI, 1.5-5.2). The latter variable also predicted a higher risk of 2-year NRM (HR, 4.0; 95% CI, 1.4-11.6) compared with HLA-matched sibling donors. Predicted 2-year NRM and 8-year PFS of a high cytogenetic risk (del(17p) and/or del(11q)) patient in remission with a matched related donor were 12% (95% CI, 3%-22%) and 54% (95% CI, 38%-69%), and for an unresponsive patient with a female partially HLA-matched unrelated donor 37% (95% CI, 12%-62%) and 38% (95% CI, 13%-63%). CONCLUSION: Low predicted NRM and high 8-year PFS in favorable transplant high cytogenetic risk patients compares favorably with outcomes with KI or BCL2i. Taking into account the amount of uncertainty for predicting survival after alloHCT and after sequential administration of KI and BCL2i, alloHCT remains a valid option for younger patients with high cytogenetic risk chronic lymphocytic leukemia with a well-HLA-matched donor.
BMT Unit Department of Hematology Rigshospitalet Copenhagen Denmark
Department of Bone Marrow Transplantation University Hospital Essen Germany
Department of Haemato Oncology University Hospital Olomouc Czech Republic
Department of Hematology BMT1 Hopital St Louis Paris France
Department of Hematology Hospital Clinic Institute of Hematology and Oncology Barcelona Spain
Department of Hematology Karolinska University Hospital Stockholm Sweden
Department of Hematology Oncology and Pneumology University Medical Center Mainz Mainz Germany
Department of Hematology Oncology Charles University Hospital Pilsen Czech Republic
Department of Hematology Radboud University Nijmegen Medical Center Nijmegen the Netherlands
Department of Hematology University Hospital Basel Switzerland
Department of Internal Medicine University Medical Center Maastricht Maastricht the Netherlands
Department of Medicine 5 University of Heidelberg Heidelberg Germany
Department of Medicine A Hematology and Oncology University of Muenster Muenster Germany
Department of Medicine Hematology Oncology University of Freiburg Freiburg Germany
Department of Stem Cell Transplantation University Hospital Eppendorf Hamburg Germany
DKMS Clinical Trials Unit Dresden Germany
Stem Cell Transplantation Unit HUCH Comprehensive Cancer Center Helsinki Finland
Citace poskytuje Crossref.org
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- $a van Gelder, Michel $u Department of Internal Medicine, University Medical Center Maastricht, Maastricht, the Netherlands. Electronic address: m.van.gelder@mumc.nl.
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- $a Baseline Characteristics Predicting Very Good Outcome of Allogeneic Hematopoietic Cell Transplantation in Young Patients With High Cytogenetic Risk Chronic Lymphocytic Leukemia - A Retrospective Analysis From the Chronic Malignancies Working Party of the EBMT / $c M. van Gelder, D. Ziagkos, L. de Wreede, A. van Biezen, P. Dreger, M. Gramatzki, M. Stelljes, NS. Andersen, N. Schaap, A. Vitek, D. Beelen, V. Lindström, J. Finke, J. Passweg, M. Eder, M. Machaczka, J. Delgado, W. Krüger, L. Raida, G. Socié, P. Jindra, B. Afanasyev, E. Wagner, Y. Chalandon, A. Henseler, S. Schoenland, N. Kröger, J. Schetelig, . ,
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- $a BACKGROUND: Patients with genetically high-risk relapsed/refractory chronic lymphocytic leukemia have shorter median progression-free survival (PFS) with kinase- and BCL2-inhibitors (KI, BCL2i). Allogeneic hematopoietic stem cell transplantation (alloHCT) may result in sustained PFS, especially in younger patients because of its age-dependent non-relapse mortality (NRM) risk, but outcome data are lacking for this population. PATIENTS AND METHODS: Risk factors for 2-year NRM and 8-year PFS were identified in patients < 50 years in an updated European Society for Blood and Marrow Transplantation registry cohort (n = 197; median follow-up, 90.4 months) by Cox regression modeling, and predicted probabilities of NRM and PFS of 2 reference patients with favorable or unfavorable characteristics were plotted. RESULTS: Predictors for poor 8-year PFS were no remission at the time of alloHCT (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.1-2.5) and partially human leukocyte antigen (HLA)-mismatched unrelated donor (HR, 2.8; 95% CI, 1.5-5.2). The latter variable also predicted a higher risk of 2-year NRM (HR, 4.0; 95% CI, 1.4-11.6) compared with HLA-matched sibling donors. Predicted 2-year NRM and 8-year PFS of a high cytogenetic risk (del(17p) and/or del(11q)) patient in remission with a matched related donor were 12% (95% CI, 3%-22%) and 54% (95% CI, 38%-69%), and for an unresponsive patient with a female partially HLA-matched unrelated donor 37% (95% CI, 12%-62%) and 38% (95% CI, 13%-63%). CONCLUSION: Low predicted NRM and high 8-year PFS in favorable transplant high cytogenetic risk patients compares favorably with outcomes with KI or BCL2i. Taking into account the amount of uncertainty for predicting survival after alloHCT and after sequential administration of KI and BCL2i, alloHCT remains a valid option for younger patients with high cytogenetic risk chronic lymphocytic leukemia with a well-HLA-matched donor.
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- $a Ziagkos, Dimitris $u Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands.
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