PMID- 21455998
OWN - NLM
STAT- MEDLINE
DCOM- 20121207
LR  - 20211020
IS  - 1097-0142 (Electronic)
IS  - 0008-543X (Print)
IS  - 0008-543X (Linking)
VI  - 117
IP  - 20
DP  - 2011 Oct 15
TI  - Nonmyeloablative allogeneic stem cell transplantation in relapsed/refractory 
      chronic lymphocytic leukemia: long-term follow-up, prognostic factors, and effect 
      of human leukocyte histocompatibility antigen subtype on outcome.
PG  - 4679-88
LID - 10.1002/cncr.26091 [doi]
AB  - BACKGROUND: The role of nonmyeloablative allogeneic stem cell transplantation 
      (NST) in the treatment of chronic lymphocytic leukemia (CLL) is not well 
      established. The authors report on long-term experience with NST in 
      relapsed/refractory CLL and define prognostic factors associated with outcome. 
      METHODS: The authors reviewed the outcome of 86 patients with relapsed/relapsed 
      CLL enrolled in sequential NST protocols. RESULTS: The median patient age was 58 
      years. Patients were heavily pretreated before transplantation, and 43 required 
      immunomanipulation after NST for persistent or recurrent disease. 
      Immunomanipulation included withdrawal of immunosuppression, rituximab, and 
      step-wise donor lymphocyte infusions. Of 43 patients receiving 
      immunomanipulation, 20 (47%) experienced a complete remission. Patients with 
      human leukocyte antigen (HLA) genotype A1(+) /A2(-) /B44(-) were more likely to 
      experience a complete remission (P = .0009), with rates of 9%, 36%, 50%, and 91%, 
      respectively, for 0, 1, 2, and 3 of these HLA factors. This resulted in 
      significant improvement in progression-free-survival rates of 68.2% at 5 years 
      for patients with all 3 HLA factors. Overall, the estimated 5-year survival rate 
      was 51%. In a multivariate model, a CD4 count of <100/mm(3) and a below normal 
      serum immunoglobulin G level at study entry were associated with a short survival 
      duration (P < .0001). CONCLUSIONS: These results confirm the potential cure of 
      relapsed/refractory CLL with NST and provide the first evidence that 
      immunoglobulin G and CD4 levels are predictive of overall survival after NST in 
      CLL and that human leukocyte antigen alleles predict response to 
      immunomanipulation.
CI  - Copyright (c) 2011 American Cancer Society.
FAU - Khouri, Issa F
AU  - Khouri IF
AD  - Department of Stem Cell Transplantation and Cellular Therapy, The University of 
      Texas MD Anderson Cancer Center, Houston, USA. ikhouri@mdanderson.org
FAU - Bassett, Roland
AU  - Bassett R
FAU - Poindexter, Nancy
AU  - Poindexter N
FAU - O'Brien, Susan
AU  - O'Brien S
FAU - Bueso-Ramos, Carlos E
AU  - Bueso-Ramos CE
FAU - Hsu, Yvonne
AU  - Hsu Y
FAU - Ferrajoli, Alessandra
AU  - Ferrajoli A
FAU - Keating, Michael J
AU  - Keating MJ
FAU - Champlin, Richard
AU  - Champlin R
FAU - Fernandez-Vina, Marcelo
AU  - Fernandez-Vina M
LA  - eng
GR  - P30 CA016672/CA/NCI NIH HHS/United States
PT  - Journal Article
DEP - 20110331
PL  - United States
TA  - Cancer
JT  - Cancer
JID - 0374236
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (Histocompatibility Antigens Class I)
RN  - 0 (Immunoglobulin G)
RN  - 0 (Immunologic Factors)
RN  - 0 (Immunosuppressive Agents)
RN  - 4F4X42SYQ6 (Rituximab)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antibodies, Monoclonal, Murine-Derived/administration & dosage
MH  - Disease-Free Survival
MH  - Female
MH  - Follow-Up Studies
MH  - Graft vs Host Disease/immunology
MH  - *Hematopoietic Stem Cell Transplantation/methods
MH  - Histocompatibility Antigens Class I/blood/*immunology
MH  - Humans
MH  - Immunoglobulin G/blood
MH  - Immunologic Factors/administration & dosage
MH  - Immunosuppressive Agents/administration & dosage
MH  - Kaplan-Meier Estimate
MH  - Leukemia, Lymphocytic, Chronic, B-Cell/*immunology/mortality/*surgery/therapy
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Recurrence
MH  - Risk Factors
MH  - Rituximab
MH  - Transplantation, Homologous
MH  - Treatment Outcome
PMC - PMC4371600
MID - NIHMS668493
EDAT- 2011/04/02 06:00
MHDA- 2012/12/12 06:00
PMCR- 2015/03/24
CRDT- 2011/04/02 06:00
PHST- 2010/09/03 00:00 [received]
PHST- 2011/01/23 00:00 [revised]
PHST- 2011/02/10 00:00 [accepted]
PHST- 2011/04/02 06:00 [entrez]
PHST- 2011/04/02 06:00 [pubmed]
PHST- 2012/12/12 06:00 [medline]
PHST- 2015/03/24 00:00 [pmc-release]
AID - 10.1002/cncr.26091 [doi]
PST - ppublish
SO  - Cancer. 2011 Oct 15;117(20):4679-88. doi: 10.1002/cncr.26091. Epub 2011 Mar 31.