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Autologous and allogeneic bone marrow transplantation for poor prognosis
patients with B-cell chronic lymphocytic leukemia
SN Rabinowe, RJ Soiffer, JG Gribben, H Daley, AS Freedman, J Daley, K Pesek, D Neuberg, G Pinkus and PR Leavitt
Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA
02115.
Twenty patients with poor prognosis B-cell chronic lymphocytic leukemia
(B-CLL) underwent uniform high-dose chemoradiotherapy followed by rescue
with multiple monoclonal antibody-purged autologous bone marrow (BM) (12
patients) or T-cell-depleted allogeneic BM from HLA-identical siblings (8
patients) in a pilot study to assess the feasibility of BM transplantation
(BMT) in this disease. All had poor prognosis disease by either staging, BM
pattern, tumor doubling time criteria, or cytogenetics. All patients
achieved remission criteria (defined as < or = 2 adenopathy, absence of
splenomegaly, < or = 20% of the intertrabecular space involved on BM
biopsy) before BMT. Despite the use of fludarabine, a median of three
treatment regimens were required to achieve BMT eligibility. After BMT, all
patients achieved complete hematologic engraftment. Toxicities were not
significantly different between autologous versus allogeneic BMT. Two toxic
deaths were observed. Of 19 evaluable patients, 17 clinical complete
clinical remissions (89%) were observed, with 2 patients (1 allogeneic and
1 autologous) exhibiting persistent BM disease. Complete clinical
remissions were documented at the phenotypic and molecular level for the
majority of patients in whom dual fluorescence for CD5 and CD20 (15 of 15;
100%) and Ig gene rearrangements (11 of 14; 79%) were performed. Although
long-term follow-up is needed to assess any potential impact on the
disease-free and overall survival of these patients, this study shows the
feasibility of using high-dose chemoradiotherapy and BMT in patients with
poor prognosis B-CLL.
Volume 82,
Issue 4,
pp. 1366-1376,
08/15/1993
Copyright © 1993 by The American Society of Hematology
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