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Allogeneic BMT Ups Survival in Relapsed CLL Patients

Allogeneic BMT Ups Survival in Relapsed CLL Patients

ORLANDO—Despite early mortality risks, HLA-matched sibling bone marrow
transplants (BMTs) offer a greater possibility of cure for patients with
relapsed chronic lymphocytic leukemia (CLL) than does chemotherapy, according
to a report presented at the 43rd Annual Meeting of the American Society of
Hematology (abstract 2011). A second report (abstract 2013) showed that
allogeneic transplant led to better event-free survival than autologous
transplant.

Mary M. Horowitz, MD, professor of medicine, Medical College of Wisconsin,
and scientific director of the International Bone Marrow Transplant Registry (IBMTR),
presented the findings of a retrospective study conducted by IBMTR and M.D.
Anderson Cancer Center and commissioned by Blue Cross and Blue Shield
Association, Chicago (abstract 2011).

"Nontransplant treatments generally have low morbidity; however, they
may also have limited efficacy, especially for patients who already have failed
multiple prior treatments," Dr. Horowitz said. "In this study,
allogeneic transplantation carried substantially higher morbidity and
significant initial mortality, but offered greater efficacy and the potential
for cure."

The study compared results of salvage allogeneic transplant using an
HLA-matched sibling as a donor with the results of non-BMT salvage therapy in
patients who had had at least one previous course of therapy for their CLL. The
transplant cases (166 patients) came from the IBMTR database, while the
chemotherapy cases (126 patients) came from M.D. Anderson. Dates of inclusion
were 1990 through 1999.

Patients over 60 were excluded from both datasets, because fewer than 5% of
the registry’s patients were 60 or older. Of the patients in the transplant
cohort, 70% were under the age of 50, compared with 28% in the traditional
chemotherapy group. Gender distribution was similar in both groups.

Distribution of performance scores pretreatment differed, with 79% in the
transplant cohort having a Karnofsky score of 90 to 100 vs only 35% of the
chemotherapy cohort. Most patients in both groups had scores of 80% or higher.

Outcomes

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