High risk CLL pts get allogeneic hematopoietic stem cell transplantation (allo-SCT).
Major cause of allo-SCT failure is relapse or disease progression.
No standard treatment available and prognosis of failed allo-SCT pts unknown.
Retrospective intention-to-treat analysis between 1998 and 2012 at MD Anderson Cancer Center.
73 pts with CLL (n=40, 55%) or Richter's transformation (RT, n=33, 45%) who failed or progressed after median of 7 months (range 0-85 months).
63 received non-myeloablative conditioning and 32 received donor lymphocyte infusion (DLI).
68 (93%) received salvage therapy.
Median of 2 treatment regimens (range 0 - 8) administered.
Most common salvage treatment regimens: rituximab (R): R-HyperCVAD (n=24, 33%), OFAR (n=13, 18%), FCR, FBR, PCR, BR (n=24, 33%), thalidomide or lenalidomide (n=21, 29%), alemtuzumab with or without chemotherapy (n=12, 16%), Bruton's Tyrosine Kinase (BTK) inhibitor (n=5, 7%).
Last follow up: 26 pts (36%) alive.
Median overall survival (OS) was 33 months (95% CI, 27– 39) and 60% of the pts were alive 2 years from time of progression.
- Median OS after allo-SCT failure/progression was 53 monthsfor CLL pts and 2 8 months for pts with RT.
- 4 pts achieved CR following first salvage treatment. The OS of these pts was 152, 41, 26+, 38+ months.
- Pts with partial response (PR), no-response (NR) or progression after first salvage treatment had similar OS.
- Patients treated with either FCR, alemtuzumab or combination chemotherapy -- no significant difference in OS.
- 4 of 5 pts treated with BTK inhibitor were alive at time of last follow-up.
- Univariable analyses: shorter OS with a higher ECOG performance status, low hemoglobin, low albumin,complex cytogenetic abnormalities and RT.
- The multivariable Cox model analyses: Hb, ECOG 3 and RT as independently associated with shorter OS.
Median OS high-risk CLL or RT from time of allo-SCT failure/progression: 33 months.
Longest OS in pts who attained CR after first salvage treatment.
OS of pts treated with BTK inhibitors not reached.
No treatment modality appeared superior.
BTK inhibitors likely to prove superior.
CR after salvage is important prognostic marker.
View the original abstract on the ASH website.
