Outcomes of allogeneic haemopoietic transplant for chronic lymphocytic leukaemia in the modern era.

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2025-05-03 DOI:10.1111/imj.70050

Luani Barge, Steven Tran, Glen Kennedy, David Ritchie, David Gottlieb, Sam Milliken, Andrew Spencer, Duncan Purtill, Travis Perera, Richard Doocey, Stephen Larsen, Andrew Butler, Peter Bardy, Matthew Greenwood, Simon Durrant, Cameron Curley, Caroline Stewart, Constantine Tam, Shalini Balendran, Pietro R Di Ciaccio, Sushrut Patil, Min-Hi Han, Nada Hamad

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引用次数: 0

Abstract

Background: Allogeneic haemopoietic stem cell transplantation (HSCT) is an effective therapy with curative potential for patients with high-risk or relapsed/refractory chronic lymphocytic leukaemia (CLL). There are limited data on the use and outcomes of HSCT in the modern era of CLL treatment.

Aims: The aim of this study was to examine the use of HSCT performed for CLL in Australia and New Zealand, including patients exposed to pathway inhibitors (PIs) prior to transplant.

Methods: Data were collected through the Australian and New Zealand Transplant and Cellular Therapy Registry for all patients who underwent HSCT for CLL between January 2009 and December 2018. Transplant outcomes were compared between two 5-year time periods: 2009-2013 and 2014-2018.

Results: Ninety-four patients underwent HSCT during 2009-2013 and 50 during 2014-2018. There was a significant reduction in non-relapse mortality (NRM) from 42% (95% confidence interval (CI): 31-52) to 23% (95% CI: 12-35, P = 0.02) between the periods; however, overall survival (OS), progression-free survival (PFS) and relapse were unchanged. Within the 2014-2018 cohort, 22 patients were PI exposed prior to transplant. At 3 years, these patients demonstrated a median OS of 54% (95% CI: 35-82), PFS of 44% (95% CI: 27-71), NRM of 25% (95% CI: 8-45) and cumulative incidence of relapse of 32% (95% CI: 14-52). In multivariate analysis, only disease in complete remission at the time of HSCT was associated with improved OS (hazard ratio: 2.54, 95% CI: 1.04-6.18).

Conclusion: Allogeneic HSCT remains a viable treatment option for select patients with CLL.

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现代异基因造血移植治疗慢性淋巴细胞白血病的疗效。

背景：同种异体造血干细胞移植（HSCT）是一种治疗高风险或复发/难治性慢性淋巴细胞白血病（CLL）的有效方法。在CLL治疗的现代时代，HSCT的使用和结果的数据有限。目的：本研究的目的是检查澳大利亚和新西兰对CLL进行HSCT的使用情况，包括移植前暴露于途径抑制剂（PIs）的患者。方法：通过澳大利亚和新西兰移植和细胞治疗登记处收集2009年1月至2018年12月期间接受HSCT治疗CLL的所有患者的数据。比较了2009-2013年和2014-2018年两个5年期的移植结果。结果：2009-2013年94例患者接受了HSCT， 2014-2018年50例。两期间非复发死亡率（NRM）显著降低，从42%（95%可信区间（CI）： 31-52）降至23% (95% CI: 12-35, P = 0.02)；然而，总生存期（OS）、无进展生存期（PFS）和复发没有变化。在2014-2018年队列中，22名患者在移植前暴露于PI。3年后，这些患者的中位OS为54% (95% CI: 35-82)， PFS为44% (95% CI: 27-71)， NRM为25% (95% CI: 8-45)，累积复发率为32% （95% CI: 14-52）。在多变量分析中，只有在移植时完全缓解的疾病与OS改善相关（风险比：2.54,95% CI: 1.04-6.18）。结论：同种异体造血干细胞移植仍然是CLL患者可行的治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.