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Chronic Leukemia

Efficacy of cisplatin-based immunochemotherapy plus alloSCT in high-risk chronic lymphocytic leukemia: final results of a prospective multicenter phase 2 HOVON study

Bone Marrow Transplantation volume 51, pages 799–806 (2016)Cite this article

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Abstract

Allogeneic stem cell transplantation (alloSCT) remains the only curative option for CLL patients. Whereas active disease at the time of alloSCT predicts poor outcome, no standard remission-induction regimen exists. We prospectively assessed outcome after cisplatin-containing immune-chemotherapy (R-DHAP) followed by alloSCT in 46 patients (median age 58 years) fulfilling modified European Society for Blood and Marrow Transplantation (EBMT) CLL Transplant Consensus criteria being refractory to or relapsed (R/R) <1 year after fludarabine or <2 years after fludarabine-based immunochemotherapy or R/R with del(17p). Twenty-nine patients received ⩾3 cycles of R-DHAP and sixteen <3 cycles (4 because of disease progression, 8 for toxicity and 4 toxic deaths). Overall rate of response to R-DHAP was 58%, 31 (67%) proceeded to alloSCT after conditioning with fludarabine and 2 Gy TBI. Twenty (65%) remained free from progression at 2 years after alloSCT, including 17 without minimal residual disease. Intention-to-treat 2-year PFS and overall survival of the 46 patients were 42 and 51% (35.5 months median follow-up); del(17p) or fludarabine refractoriness had no impact. R-DHAP followed by alloSCT is a reasonable treatment to be considered for high-risk CLL patients without access or resistance to targeted therapies.

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Acknowledgements

The data management was financially supported by the Dutch Cancer Foundation (Koningin Wilhelmina Fonds, Amsterdam, The Netherlands). Monique Steijaert, Fokje Spoelstra and Ine Meulendijks (trial and data managers, HOVON Data Center) are acknowledged for their excellent help. Off-label rituximab was generously supplied by Roche Nederland (Woerden, The Netherlands).

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

    M van Gelder

  2. Department of Hematology and Lymphoma and Myeloma Center, Academic Medical Center, Amsterdam, The Netherlands

    M H van Oers & A P Kater

  3. HOVON Data Center, Erasmus Medical Center, Rotterdam, The Netherlands

    W G Alemayehu

  4. Department of Hematology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    M C J Abrahamse-Testroote & J J Cornelissen

  5. Department of Hematology, Free University Medical Center, Amsterdam, The Netherlands

    M E Chamuleau

  6. Department of Hematology, Ziekenhuis Netwerk Antwerpen Stuivenberg, Antwerpen, Belgium

    P Zachée

  7. Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands

    M Hoogendoorn

  8. Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands

    M Nijland

  9. Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands

    E J Petersen

  10. Department of Internal Medicine, Spaarne Ziekenhuis, Hoofddorp, The Netherlands

    A Beeker

  11. Department of Internal Medicine, Ziekenhuis Amstelland, Amstelveen, The Netherlands

    G-J Timmers

  12. Department of Internal Medicine, Isala Klinieken, Zwolle, The Netherlands

    L Verdonck

  13. Department of Internal Medicine, Medisch Centrum Alkmaar, Alkmaar, The Netherlands

    M Westerman

  14. Department of Internal Medicine, Antonius ziekenhuis Nieuwegein, Nieuwegein, The Netherlands

    O de Weerdt

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  1. M van Gelder
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van Gelder, M., van Oers, M., Alemayehu, W. et al. Efficacy of cisplatin-based immunochemotherapy plus alloSCT in high-risk chronic lymphocytic leukemia: final results of a prospective multicenter phase 2 HOVON study. Bone Marrow Transplant 51, 799–806 (2016). https://doi.org/10.1038/bmt.2016.9

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