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Chronic Leukemia

High-dose therapy and autologous hematopoietic cell transplantation as front-line consolidation in chronic lymphocytic leukemia: a systematic review

Bone Marrow Transplantation volume 50, pages 1069–1074 (2015)Cite this article

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A Corrigendum to this article was published on 05 August 2015

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Abstract

High-dose therapy (HDT) followed by autologous hematopoietic cell transplantation (auto-HCT) is offered to patients with chronic lymphocytic leukemia (CLL) both as front-line consolidation and in the relapsed setting. The role of HDT in the front-line consolidation setting in CLL is uncertain. Literature search of PUBMED and Cochrane until 14 November 2014 and the last 2 years of abstracts from relevant conferences was undertaken. End points included benefits (overall survival; OS, PFS, event-free survival; EFS) and harms (adverse events, secondary malignancies, treatment-related mortality). The search identified 495 references of which four studies met inclusion criteria. Altogether, 301 patients were randomized to the HDT/auto-HCT arm and 299 patients to the control arm. Offering front-line HDT/auto-HCT did not result in statistically significant improvement in OS (Hazard ratio (HR)=0.91; 95% confidence interval (CI)= 0.62, 1.33) or PFS (HR=0.70; 95% CI= 0.32, 1.52). There was a statistically significant advantage favoring HDT/auto-HCT for EFS (HR=0.46; 95% CI= 0.26, 0.83). Moreover, HDT/auto-HCT did not result in higher rate of secondary malignancy (risk ratio=1.06; 95% CI=0.55, 2.05) or treatment-related mortality (risk ratio=1.32; 95% CI= 0.43, 4.06). Offering HDT/auto-HCT as front-line consolidation in patients with CLL does not improve OS. At present this approach should not be offered outside the context of a clinical trial.

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  • 05 August 2015

    This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication

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Acknowledgements

Parts of this paper were presented at the Annual Meeting of the American Society of Hematology on 6 December 2014 in San Francisco, CA, USA (poster presentation 1306).

Author contributions

TR, AK, BD and MAK-D contributed to research design. TR and MAK-D acquired and analyzed the data. AK, BD and MAK-D contributed to interpretation of data. TR and MAK-D drafted the paper. AK and BD edited the paper with critical revisions. TR, AK, BD and MAK-D all approved the submitted and final versions of this paper.

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Authors and Affiliations

  1. Center for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    T Reljic, A Kumar & B Djulbegovic

  2. Department of Oncologic Sciences, H. Lee Moffitt Cancer Center/University of South Florida, Morsani College of Medicine, Tampa, FL, USA

    A Kumar & B Djulbegovic

  3. Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    B Djulbegovic & M A Kharfan-Dabaja

  4. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    M A Kharfan-Dabaja

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  1. T Reljic
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  4. M A Kharfan-Dabaja
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Correspondence to A Kumar.

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Reljic, T., Kumar, A., Djulbegovic, B. et al. High-dose therapy and autologous hematopoietic cell transplantation as front-line consolidation in chronic lymphocytic leukemia: a systematic review. Bone Marrow Transplant 50, 1069–1074 (2015). https://doi.org/10.1038/bmt.2015.69

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