ORLANDODespite 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.