Early autologous stem cell transplantation for chronic lymphocytic leukemia: long-term follow-up of the German CLL Study Group CLL3 trial
Peter Dreger, Hartmut Döhner, Fabienne McClanahan, Raymonde Busch, Matthias Ritgen, Hildegard Greinix, Anna-Maria Fink, Wolfgang Knauf, Michael Stadler, Michael Pfreundschuh, Ulrich Dührsen, Günter Brittinger, Manfred Hensel, Johannes Schetelig, Dirk Winkler, Andreas Bühler, Michael Kneba, Norbert Schmitz, Michael Hallek, Stephan Stilgenbauer, German CLL Study Group, Peter Dreger, Michael Kneba, Norbert Schmitz, Ruth Sonnen, Stephan Stilgenbauer, Hartmut Döhner, Manfred Hensel, Anthony D Ho, Hildegard Greinix, Uli Jäger, Bernd Hertenstein, Michael Stadler, Wolfgang Schultze, Charite Benjamin Franklin, Wolfgang Knauf, Günther Brittinger, Dietrich Beelen, Lorenz Trümper, Michael Pfreundschuh, Joachim Kienast, Marcus Hentrich, Wolfgang Aulitzky, Bernd Metzner, Hans Edgar Reis, Michael Koenigsmann, Astrid Franke, Barbara Eichhorst, Thomas Wagner, Siegfried Seeber, Rüdiger Hoffmann, Martin Wilhelm, Yon Ko, Christoph Nerl, Kerstin Stahlhut, Gabriele Döring, Bertold Emmerich, Johannes Schetelig, Martin Bornhäuser, Hartmut Kirchner, Hartmut Link, Wolf-Dietrich Hirschmann, Georg Hopfinger, Michael Schaefers, Hannes Wandt, Rudolf Schlag, Michael Eckart, Georg Maschmeyer, Katrin Kolbe, Rainer Haas, Johannes Saal, Heinz Dürk, Heinrich Bartels, Mathias Freund, Gottfried Dölken, Herbert Sayer, Rainer Schwerdtfeger, Georg Schließer, Monika Grundheber, Peter Dreger, Hartmut Döhner, Fabienne McClanahan, Raymonde Busch, Matthias Ritgen, Hildegard Greinix, Anna-Maria Fink, Wolfgang Knauf, Michael Stadler, Michael Pfreundschuh, Ulrich Dührsen, Günter Brittinger, Manfred Hensel, Johannes Schetelig, Dirk Winkler, Andreas Bühler, Michael Kneba, Norbert Schmitz, Michael Hallek, Stephan Stilgenbauer, German CLL Study Group, Peter Dreger, Michael Kneba, Norbert Schmitz, Ruth Sonnen, Stephan Stilgenbauer, Hartmut Döhner, Manfred Hensel, Anthony D Ho, Hildegard Greinix, Uli Jäger, Bernd Hertenstein, Michael Stadler, Wolfgang Schultze, Charite Benjamin Franklin, Wolfgang Knauf, Günther Brittinger, Dietrich Beelen, Lorenz Trümper, Michael Pfreundschuh, Joachim Kienast, Marcus Hentrich, Wolfgang Aulitzky, Bernd Metzner, Hans Edgar Reis, Michael Koenigsmann, Astrid Franke, Barbara Eichhorst, Thomas Wagner, Siegfried Seeber, Rüdiger Hoffmann, Martin Wilhelm, Yon Ko, Christoph Nerl, Kerstin Stahlhut, Gabriele Döring, Bertold Emmerich, Johannes Schetelig, Martin Bornhäuser, Hartmut Kirchner, Hartmut Link, Wolf-Dietrich Hirschmann, Georg Hopfinger, Michael Schaefers, Hannes Wandt, Rudolf Schlag, Michael Eckart, Georg Maschmeyer, Katrin Kolbe, Rainer Haas, Johannes Saal, Heinz Dürk, Heinrich Bartels, Mathias Freund, Gottfried Dölken, Herbert Sayer, Rainer Schwerdtfeger, Georg Schließer, Monika Grundheber
Abstract
The CLL3 trial was designed to study intensive treatment including autologous stem cell transplantation (autoSCT) as part of first-line therapy in patients with chronic lymphocytic leukemia (CLL). Here, we present the long-term outcome of the trial with particular focus on the impact of genomic risk factors, and we provide a retrospective comparison with patients from the fludarabine-cyclophosphamide-rituximab (FCR) arm of the German CLL Study Group (GCLLSG) CLL8 trial. After a median observation time of 8.7 years (0.3-12.3 years), median progression-free survival (PFS), time to retreatment, and overall survival (OS) of 169 evaluable patients, including 38 patients who did not proceed to autoSCT, was 5.7, 7.3, and 11.3 years, respectively. PFS and OS were significantly reduced in the presence of 17p- and of an unfavorable immunoglobulin heavy variable chain mutational status, but not of 11q-. Five-year nonrelapse mortality was 6.5%. When 110 CLL3 patients were compared with 126 matched patients from the FCR arm of the CLL8 trial, 4-year time to retreatment (75% vs 77%) and OS (86% vs 90%) was similar despite a significant benefit for autoSCT in terms of PFS. In summary, early treatment intensification including autoSCT can provide very effective disease control in poor-risk CLL, although its clinical benefit in the FCR era remains uncertain. The trial has been registered with www.clinicaltrials.gov as NCT00275015.
Source: PubMed