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Hematopoietic Cell Transplantation for TP53-Mutant or Deleted CLL: Long-Term Outcomes

By: Sarah Campen, PharmD
Posted: Monday, September 28, 2020

The sequence of alemtuzumab-based remission induction and allogeneic hematopoietic cell transplantation (alloHCT) for patients with TP53-mutant or -deleted chronic lymphocytic leukemia (CLL) in their first remission was the “most promising” treatment approach of a prospective observational study that began a decade ago. However, the treatment is outdated in the light of today’s treatment options for patients with TP53-mutant or -deleted CLL, according to Peter Dreger, MD, of the University of Heidelberg, Germany, and colleagues. They presented the long-term outcomes of the study in Bone Marrow Transplantation.

Although newer treatment options—including Bruton’s tyrosine kinase inhibitors or B-cell lymphoma 2 inhibitors—are now preferable, “our data indicate that remission induction with alemtuzumab prior to alloHCT should not be excluded for patients with relapsed/refractory TP53-mutant or -deleted CLL who lack better options,” stated the authors.

The final analysis of the study included data from 39 patients with a median age of 59 years who were enrolled between 2010 and 2012. At last follow-up, 19 patients were alive, with a median follow-up of 6 years; of these patients, 11 had minimal residual disease–negative disease at last assessment.

The cause of death in seven patients was related to graft-versus-host disease (GVHD) with or without concomitant infection. Patients who had experienced acute GVHD grades II to IV or chronic GVHD had a significantly lower risk of relapse (P = .01).

“Notably, the best subgroup consisted of 10 patients who had received alemtuzumab with or without high-dose corticosteroids for remission induction and proceeded to alloHCT in [the] first remission,” stated the authors.

Disclosure: For full disclosures of the study authors, visit www.nature.com.



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