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High-Risk CLL: Hematopoietic Stem Cell Transplantation Followed by Immune Intervention

By: Kelly M. Hennessey, PhD
Posted: Tuesday, September 1, 2020

A prospective study was conducted to evaluate reduced-intensity conditioning hematopoietic stem cell transplantation (HSCT) followed by minimal residual disease (MRD)-driven immune-intervention, to achieve MRD negative status at 12-months post-HSCT. Nathalie Dhédin, MD, of Unité Adolescents et Jeunes Adultes, Hôpital St Louis, Assistance Publique - Hôpitaux de Paris, and colleagues found that MRD-negative status was predictive of improvement in progression-free survival, overall survival, and reduction in the cumulative incidence of relapse. Their study findings were published in Haematologica.

In this study, 42 patients received a reduced-intensity conditioning regimen before HSCT. All patients were in partial remission (n = 32) or complete remission (n = 8) and had received a median of two lines of treatment before HSCT. By month 12, MRD-negative status was achieved in 27 out of 42 patients versus 6 before HSCT. Of the total, seven patients died; four deaths were due to graft-versus-host-disease or infection. At the median 3-year follow-up, the rates of overall survival, progression-free survival, and nonrelapse mortality were 86.9%, 62.9%, and 95.5%, respectively. The 3-year rate of cumulative incidence of relapse was 29.6%. At 12 months after transplantation, MRD-negative status was achieved in 64% of all patients, and in 77% of patients being assessed at this time point versus 14.2% before transplantation.

“This report shows the feasibility of MRD-driven immune intervention following ATG-based reduced-intensity conditioning allogeneic HSCT in CLL. These data highlight the importance of repeatedly monitoring post-HSCT MRD to guide early cyclosporine discontinuation in patients with day-90 MRD-positive and with no graft-versus-host disease,” summarized the researchers.   

Disclosure: No disclosure information was provided by the study authors.



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