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Graft-Versus-Host Effects

Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease

Bone Marrow Transplantation volume 36, pages 825–830 (2005)Cite this article

Summary:

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.

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Acknowledgements

We thank the medical and nursing staff in the Toronto and Vancouver programs for their expert care of these patients, Dr John Spinelli and Alan Le for statistical assistance, Janet Nitta, Daphne Brockington and Daryl Armstrong for data management, and Shawna Moore for manuscript preparation.

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Authors and Affiliations

  1. Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver Hospital & Health Sciences Centre, BC Cancer Agency and University of BC, Vancouver, British Columbia, Canada

    C L Toze, M J Barnett, J D Shepherd, E A Conneally, D E Hogge, S H Nantel, T J Nevill, H J Sutherland, J C Lavoie, D L Forrest, K W Song & C A Smith

  2. Division of Medical Oncology and Hematology, Princess Margaret Hospital, and University of Toronto, Toronto, Ontario, Canada

    A Galal, T L Kiss, H A Messner & J Lipton

  3. Division of Medical Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada

    J M Connors

  4. Division of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada

    N J Voss

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Correspondence to C L Toze.

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Toze, C., Galal, A., Barnett, M. et al. Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease. Bone Marrow Transplant 36, 825–830 (2005). https://doi.org/10.1038/sj.bmt.1705130

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