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Allogeneic Haploidentical Blood or Marrow Transplantation with Post-Transplant Cyclophosphamide in Chronic Lymphocytic Leukemia
Paul, S., Tsai, H. L., Lowery, P., Fuchs, E. J., Luznik, L., Bolanos-Meade, J., Swinnen, L. J., Shanbhag, S., Wagner-Johnston, N., Varadhan, R., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Abstract
Allogeneic blood or marrow transplantation (alloBMT) remains the only treatment for chronic lymphocytic leukemia (CLL) with curative potential. While post-transplant cyclophosphamide (PTCy) reduces alloBMT toxicity by decreasing graft-versus-host disease (GVHD), its effect on CLL alloBMT outcomes is unknown. We studied 64 consecutive CLL patients undergoing non-myeloablative (NMA) haploidentical alloBMT at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. The 4-year overall survival (OS) was 52% (95% confidence interval [CI]: 40-68%) and progression free survival (PFS) was 37% (95% CI: 26-54%) for all 64 patients undergoing alloBMT. In total, 6 patients suffered from engraftment failure. PTCy prophylaxis was associated with a modest cumulative GVHD incidence: 27% (95% CI: 15-38%) 1-year grade II-IV acute GVHD, and 17% (95% CI: 7-26%) 2-year chronic GVHD. We demonstrate NMA haploidentical alloBMT with PTCy is a safe and effective treatment option.