1. ¹Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver Hospital & Health Sciences Centre, BC Cancer Agency and University of BC, Vancouver, British Columbia, Canada
2. ²Division of Medical Oncology and Hematology, Princess Margaret Hospital, and University of Toronto, Toronto, Ontario, Canada
3. ³Division of Medical Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada
4. ⁴Division of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada

Correspondence: Dr CL Toze, Division of Hematology, Department of Medicine, Leukemia/BMT Program of BC, Vancouver Hospital & Health Sciences Centre, 950 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 4E3. E-mail: ctoze@bccancer.bc.ca

Received 27 August 2004; Accepted 15 June 2005; Published online 5 September 2005.

Abstract

In all, 30 patients with CLL proceeded to myeloablative allogeneic BMT using related (n=20, 67%) or unrelated (n=10) donors, at the Princess Margaret Hospital (Toronto) (n=20) or the Leukemia/BMT Program of BC (Vancouver) (n=10), from 1989 to 2001. Median (range) interval from diagnosis to BMT was 4.8 (0.3–13) years, median number of prior therapies was three and median age 48 years. The preparative regimen included total body irradiation in 15 (50%). In all, 14 of 30 patients (47%) are alive, with median (range) follow up of 4.3 (2.4–10.5) years. All are in complete remission, two following therapy for post-BMT progression. Actuarial overall (OS) and event-free survival (EFS) at 5 years is 39% (OS 48% for related donor and 20% for unrelated donor BMT); cumulative incidence of nonrelapse mortality (NRM) and relapse is 47 and 19%, respectively. Both acute (RR=0.008, P=0.01) and chronic (RR=0.006, P=0.02) Graft-versus-host disease (GVHD) were associated with markedly decreased risk of relapse. Patients receiving grafts from unrelated donors had increased NRM (RR=3.6, P=0.02) and decreased OS (RR of death=3.4, P=0.002). Allogeneic BMT has resulted in long-term EFS in approximately 40% of patients with CLL. There is evidence for a strong graft-versus-leukemia effect associated with acute and chronic GVHD, resulting in near complete protection from relapse.