Long-term survival of patients with CLL after allogeneic transplantation: A report from the European Society for Blood and Marrow Transplantation

Van Gelder, M.; De Wreede, L. C.; Bornhauser, M.; Niederwieser, D.; Karas, M.; Anderson, N. S.; Gramatzki, M.; Dreger, P.; Michallet, M.; Petersen, E.; Bunjes, D.; Potter, M.; Beelen, D.; Cornelissen, J. J.; Yakoub-Agha, I.; Russell, N. H.; Finke, J.; Schoemans, H.; Vitek, A.; Urbano-Ispizua, A.; Blaise, D.; Volin, L.; Chevallier, P.; Caballero, D.; Putter, H.; Van Biezen, A.; Henseler, A.; Schonland, S.; Kroger, N.; Schetelig, J.; Ehninger, G.; Jindra, P.; Sengeloev, H.; Potter, M.; Russell, N.; Vitek, A.; Ispizua, A. U.; Arnold, R.; Veelken, J. H.; Mufti, G.; Milpied, N.; Benedetto, B.; Schaap, M.; Leblond, V.; Nikolousis, M.; Hallek, M.; Passweg, J.; Ljungman, P.; Masszi, T.; Stelljes, M.; Browne, P.; Glass, B.; Espiga, C. R.; Bourhis, J. H.; Roussy, G.; Gribben, J.; Foa, R.; Sierra, J.; Mayer, J.; Thomson, K.; Meijer, E.; Blau, W.; Holler, E.; Bacigalupo, A.; Guilhot, F.; Carlson, K.; Zachee, P.; Ifrah, N.; Marin, J. R. C.; Socie, G.; Mcquaker, G.; Cortelezzi, A.; Lenhoff, S.; Tischer, J.; Irrera, G.; Fanin, R.; Beguin, Y.; Nagler, A.; Mackinnon, S.; Itala-Remes, M.; Deconinck, E.; Wulf, G.; Corradini, P.; Gilleece, M.; Wing, B.; Peniket, A.; Ganser, A.; Stuhler, G.; Faber, E.; Komarnicki, M.; Kanz, L.; Brune, M.; Lamy, T.; Sanz, M.; Kyrcz-Krzemien, S.; Orchard, K.; Hunter, A.; Sandstedt, A.; Fegueux, N.; Bandini, G.; Robinson, S.; Craddock, C.; Crawley, C.; Griskevicius, L.; Bloor, A.; Reman, O.; Hilgendorf, I.; Cannell, P.; Ciceri, F.; Kalhs, P.; Sica, S.; Greinix, H.; Scime, R.; Selleslag, D.; Kruger, W.; Huynh, A.; Einsele, H.; Bittenbring, J.; Olivieri, A.; Hermine, O.; Gedde-Dahl, T.; Zsiros, J.; Guyotat, D.; Cordonnier, C.; Campos, A.; Casini, M.; Martinelli, G.; Muller, L. P.; Van Imhoff, G.; Neubauer, A.; Lioure, B.; Hamladji, R. -M.; Noens, L.; Theobald, M.; Salvi, F.; Ram, R.; Poire, X.; Or, R.; Chalandon, Y.; Solano, C.; Wilson, K.; Santasusana, J. M. R.; Karakasis, D.; Schafer-Eckart, K.; Wahlin, A.; Mohty, M.; Velardi, A.; Bron, D.; Alegre, A.; Cairoli, R.; Marotta, G.; Lange, A.; Narni, F.; Fauser, A.; Rambaldi, A.; Guillerm, G.; Heras, I.; Snowden, J.; Wiktor-Jedrzejczak, W.; Schanz, U.; Cahn, J. Y.; Abecasis, M.; Kobbe, G.; Salim, R.; Junghanss, C.; Segel, E. K.; Clement, L.; Zak, P.; Metzner, B.; Espigado, I.; Tilly, H.; Schroyens, W.; Favre, C.; Russo, D.; Gastl, G.; Bay, J. -O.; Alessandrino, E. P.; Majolino, I.; Bosi, A.; Zuckerman, T.; Aljurf, M.; Thomson, J.; Pioltelli, P.; Anagnostopoulos, A.; Schouten, H.; Tholouli, E.; Gurman, G.; Vural, F.; Zver, S.; Muniz, S. G.; Afanasyev, B.; Pohlreich, D.; Hellmann, A.; Rosler, W.; Martin, S.; Apperley, J.; Finnegan, D.; Renaud, M.; Nemet, D.; Culligan, D.; Castagna, L.; Cascavilla, N.; Koh, M.; Chacon, M. J.; Ozdogu, H.; Spencer, A.; Llamas, C. V.; Grasso, M.; Lopez, S. G.; Benedetti, F.; Deeren, D.; De Revel, T.; Musso, M.; Halaburda, K.; Sureda, A.; Angelucci, E.; Diez-Martin, J. L.; Hunter, H.; Koc, Y.; Bordessoule, D.; Fouillard, L.; Di Bartolomeo, P.; Mazza, P.; Novitzky, N.; Peschel, C.; Lopez, J. L. B.; Cascon, M. J. P.; Romeril, K. R.; Schots, R.; Brussel, H.; Koistinen, P.; Arcese, W.; Aktan, M.; Rodeghiero, F.; Butler, A.; Pizzuti, M.; Melpignano, A.; Carella, A. M.; Valcarcel, D.; De Toledo Codina, J. S.; Galieni, P.; Bader, P.; Hahn,; Cavanna, L.; Sucak, G.; Broom, A. J. M.; Garcia, P. G.; Nicolas-Virelizier, E.; Rizzoli, V.; Witz, F.; Potter, M.; Collin, M.; Ringhoffer, M.; Kansu, E.; Martin, H.; Moraleda, J.; Pranger, D.; Greil, R.; Bazarbachi, A.; Ozturk, M.; Fagioli, F.; Jantunen, E.; Yeshurun, M.; Altuntas, F.; Bassan, R.; Rohrlich, P. -S.; Jimenez, S.; Glaisner, S.; Vinante, O.; Clausen, J.; Lopez-Jimenez, J.; Theunissen, K.; Specchia, G.; Pavone, V.; Krauter, J.; Edwards, D.; Rifon, J.; Everaus, H.; Da Prada, G. A.; Wattad, M.; Milone, G.; Walewski, J.; Thieblemont, C.; Nasa, G. L.; Duchosal, M.; Ferrara, F.; Devidas, A.; Delmer, A.; Degos, L.

doi:10.1038/bmt.2016.282

Even with the availability of targeted drugs, allogeneic hematopoietic cell transplantation (allo-HCT) is the only therapy with curative potential for patients with CLL. Cure can be assessed by comparing long-term survival of patients to the matched general population. Using data from 2589 patients who received allo-HCT between 2000 and 2010, we used landmark analyses and methods from relative survival analysis to calculate excess mortality compared with an age-, sex- and calendar year-matched general population. Estimated event-free survival, overall survival and non-relapse mortality (NRM) 10 years after allo-HCT were 28% (95% confidence interval (CI), 25-31), 35% (95% CI, 32-38) and 40% (95% CI, 37-42), respectively. Patients who passed the 5-year landmark event-free survival (N=394) had a 79% probability (95% CI, 73-85) of surviving the subsequent 5 years without an event. Relapse and NRM contributed equally to treatment failure. Five-year mortality for 45- and 65-year-old reference patients who were event-free at the 5-year landmark was 8% and 47% compared with 3% and 14% in the matched general population, respectively. The prospect of long-term disease-free survival remains an argument to consider allo-HCT for young patients with high-risk CLL, and programs to understand and prevent late causes of failure for long-term survivors are warranted, especially for older patients.