No studies have been reported so far on bridging treatment with idelalisib for patients with chronic lymphocytic leukemia (CLL) prior to allogeneic hematopoietic cell transplantation (alloHCT). To study potential carry-over effects of idelalisib and to assess the impact of pathway-inhibitor (PI) failure we performed a retrospective EBMT registry-based study. Patients with CLL who had a history of idelalisib treatment and received a first alloHCT between 2015 and 2017 were eligible. Data on 72 patients (median age 58 years) were analyzed. Forty percent of patients had TP53mut/del CLL and 64% had failed on at least one PI. No primary graft failure occurred. Cumulative incidences of acute GVHD °II-IV and chronic GVHD were 51% and 39%, respectively. Estimates for 2-year overall survival (OS), progression-free survival (PFS), and cumulative incidences of relapse/progression (CIR) and non-relapse mortality NRM were 59%, 44%, 25%, and 31%. In univariate analysis, drug sensitivity was a strong risk factor. For patients who had failed neither PI treatment nor chemoimmunotherapy (CIT) the corresponding 2-year estimates were 73%, 65%, 15%, and 20%, respectively. In conclusion, idelalisib may be considered as an option for bridging therapy prior to alloHCT. Owing to the high risk for acute GVHD intensified clinical monitoring is warranted.

Birmingham Heartlands Hospital Birmingham UK

Bone Marrow Transplant Unit ASST Spedali Civili di Brescia University of Brescia Brescia Italy

Cancer Institute and Institute of Immunity and Transplantation University College London Hospital London UK

Centre Hospitalier Universitaire de Lille LIRIC INSERM U995 Université de Lille Lille France

Centre Hospitalier Universitaire Institut d'Hématologie Normandie University Caen France

CHU Bordeaux Pessac France

CHU Nantes Nantes France

Department of Hematology Necker Hospital and INSERM U1163 Imagine Institute University of Paris Paris France

Department of Medical Statistics and Bioinformatics Leiden University Medical Center Leiden The Netherlands

DKMS Dresden Germany

EBMT Data Office Leiden The Netherlands

Helios Dr Horst Schmidt Kliniken Wiesbaden Germany

Hope Directorate Dublin Ireland

Hopital Jean Minjoz Besancon France

Hopital la Pitié Salpêtrière Universite Paris 4 Paris France

Hopital St Louis Paris France

Hôpital St Louis Paris France

Hospital Clinic Barcelona Spain

Inserm U1245 and Department of Hematology Centre Henri Becquerel Normandie University Rouen France

Maladies du Sang CHU Angers Angers France

Medical Clinic 1 University Hospital Dresden Germany

Service d'Hématologie Clinique et de Thérapie Cellulaire Creteil CHU Henri Mondor Créteil France

Service Therapie Cellulaire and Hematologie Cliniquer Centre Hospitalier Universitaire Clermont Ferrand France

University Hospital Brno Brno Czech Republic

University Hospital Eppendorf Hamburg Germany

University Hospital Essen Germany

University Hospital Maastricht Maastricht The Netherlands

University of Heidelberg Heidelberg Germany

University of Saarland Homburg Saar Germany

Bone Marrow Transplant. 2022 Feb;57(2):330. doi: 10.1038/s41409-021-01516-2. PubMed

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