Autologous and allogeneic bone marrow transplantation for poor prognosis patients with B-cell chronic lymphocytic leukemia

Susan N. Rabinowe, Robert J. Soiffer, John G. Gribben, Heather Daley, Arnold S. Freedman, John Daley, Kelly Pesek, Donna Neuberg, Geraldine Pinkus, Pearl R. Leavitt, Neil A. Spector, Michael L. Grossbard, Kenneth Anderson, Michael Robertson, Peter Mauch, Karen Chayt-Marcus, Jerome Ritz, Lee M. Nadler

Research output: Contribution to journalArticle

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Abstract

Twenty patients with poor prognosis B-cell chronic lymphocytic leukemia (B-CLL) underwent uniform high-dose chemoradiotherapy followed by rescue with multiple monoclonal antibody-purged autologous bone marrow (BM) (12 patients) or T-cell-depleted allogeneic BM from HLA-identical siblings (8 patients) in a pilot study to assess the feasibility of BM transplantation (BMT) in this disease. All had poor prognosis disease by either staging, BM pattern, tumor doubling time criteria, or cytogenetics. All patients achieved remission criteria (defined as ≤2 cm adenopathy, absence of splenomegaly, ≤20% of the intertrabecular space involved on BM biopsy) before BMT. Despite the use of fludarabine, a median of three treatment regimens were required to achieve BMT eligibility. After BMT, all patients achieved complete hematologic engraftment. Toxicities were not significantly different between autologous versus allogeneic BMT. Two toxic deaths were observed. Of 19 evaluable patients, 17 clinical complete clinical remissions (89%) were observed, with 2 patients (1 allogeneic and 1 autologous) exhibiting persistent BM disease. Complete clinical remissions were documented at the phenotypic and molecular level for the majority of patients in whom dual fluorescence for CD5 and CD20 (15 of 15; 100%) and Ig gene rearrangements (11 of 14; 79%) were performed. Although long-term follow-up is needed to assess any potential impact on the disease-free and overall survival of these patients, this study shows the feasibility of using high-dose chemoradiotherapy and BMT in patients with poor prognosis B-CLL.

Original languageEnglish (US)
Pages (from-to)1366-1376
Number of pages11
JournalBlood
Volume82
Issue number4
StatePublished - Aug 15 1993
Externally publishedYes

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Homologous Transplantation
B-Cell Chronic Lymphocytic Leukemia
Bone Marrow Transplantation
Bone
Cells
Chemoradiotherapy
Transplantation
Bone Marrow
T-cells
Biopsy
Poisons
Bone Marrow Diseases
Toxicity
Tumors
Genes
Fluorescence
Immunoglobulin Genes
Monoclonal Antibodies
Gene Rearrangement
Splenomegaly

ASJC Scopus subject areas

  • Hematology

Cite this

Rabinowe, S. N., Soiffer, R. J., Gribben, J. G., Daley, H., Freedman, A. S., Daley, J., ... Nadler, L. M. (1993). Autologous and allogeneic bone marrow transplantation for poor prognosis patients with B-cell chronic lymphocytic leukemia. Blood, 82(4), 1366-1376.

Autologous and allogeneic bone marrow transplantation for poor prognosis patients with B-cell chronic lymphocytic leukemia. / Rabinowe, Susan N.; Soiffer, Robert J.; Gribben, John G.; Daley, Heather; Freedman, Arnold S.; Daley, John; Pesek, Kelly; Neuberg, Donna; Pinkus, Geraldine; Leavitt, Pearl R.; Spector, Neil A.; Grossbard, Michael L.; Anderson, Kenneth; Robertson, Michael; Mauch, Peter; Chayt-Marcus, Karen; Ritz, Jerome; Nadler, Lee M.

In: Blood, Vol. 82, No. 4, 15.08.1993, p. 1366-1376.

Research output: Contribution to journalArticle

Rabinowe, SN, Soiffer, RJ, Gribben, JG, Daley, H, Freedman, AS, Daley, J, Pesek, K, Neuberg, D, Pinkus, G, Leavitt, PR, Spector, NA, Grossbard, ML, Anderson, K, Robertson, M, Mauch, P, Chayt-Marcus, K, Ritz, J & Nadler, LM 1993, 'Autologous and allogeneic bone marrow transplantation for poor prognosis patients with B-cell chronic lymphocytic leukemia', Blood, vol. 82, no. 4, pp. 1366-1376.
Rabinowe SN, Soiffer RJ, Gribben JG, Daley H, Freedman AS, Daley J et al. Autologous and allogeneic bone marrow transplantation for poor prognosis patients with B-cell chronic lymphocytic leukemia. Blood. 1993 Aug 15;82(4):1366-1376.
Rabinowe, Susan N. ; Soiffer, Robert J. ; Gribben, John G. ; Daley, Heather ; Freedman, Arnold S. ; Daley, John ; Pesek, Kelly ; Neuberg, Donna ; Pinkus, Geraldine ; Leavitt, Pearl R. ; Spector, Neil A. ; Grossbard, Michael L. ; Anderson, Kenneth ; Robertson, Michael ; Mauch, Peter ; Chayt-Marcus, Karen ; Ritz, Jerome ; Nadler, Lee M. / Autologous and allogeneic bone marrow transplantation for poor prognosis patients with B-cell chronic lymphocytic leukemia. In: Blood. 1993 ; Vol. 82, No. 4. pp. 1366-1376.
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abstract = "Twenty patients with poor prognosis B-cell chronic lymphocytic leukemia (B-CLL) underwent uniform high-dose chemoradiotherapy followed by rescue with multiple monoclonal antibody-purged autologous bone marrow (BM) (12 patients) or T-cell-depleted allogeneic BM from HLA-identical siblings (8 patients) in a pilot study to assess the feasibility of BM transplantation (BMT) in this disease. All had poor prognosis disease by either staging, BM pattern, tumor doubling time criteria, or cytogenetics. All patients achieved remission criteria (defined as ≤2 cm adenopathy, absence of splenomegaly, ≤20{\%} of the intertrabecular space involved on BM biopsy) before BMT. Despite the use of fludarabine, a median of three treatment regimens were required to achieve BMT eligibility. After BMT, all patients achieved complete hematologic engraftment. Toxicities were not significantly different between autologous versus allogeneic BMT. Two toxic deaths were observed. Of 19 evaluable patients, 17 clinical complete clinical remissions (89{\%}) were observed, with 2 patients (1 allogeneic and 1 autologous) exhibiting persistent BM disease. Complete clinical remissions were documented at the phenotypic and molecular level for the majority of patients in whom dual fluorescence for CD5 and CD20 (15 of 15; 100{\%}) and Ig gene rearrangements (11 of 14; 79{\%}) were performed. Although long-term follow-up is needed to assess any potential impact on the disease-free and overall survival of these patients, this study shows the feasibility of using high-dose chemoradiotherapy and BMT in patients with poor prognosis B-CLL.",
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AU - Freedman, Arnold S.

AU - Daley, John

AU - Pesek, Kelly

AU - Neuberg, Donna

AU - Pinkus, Geraldine

AU - Leavitt, Pearl R.

AU - Spector, Neil A.

AU - Grossbard, Michael L.

AU - Anderson, Kenneth

AU - Robertson, Michael

AU - Mauch, Peter

AU - Chayt-Marcus, Karen

AU - Ritz, Jerome

AU - Nadler, Lee M.

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N2 - Twenty patients with poor prognosis B-cell chronic lymphocytic leukemia (B-CLL) underwent uniform high-dose chemoradiotherapy followed by rescue with multiple monoclonal antibody-purged autologous bone marrow (BM) (12 patients) or T-cell-depleted allogeneic BM from HLA-identical siblings (8 patients) in a pilot study to assess the feasibility of BM transplantation (BMT) in this disease. All had poor prognosis disease by either staging, BM pattern, tumor doubling time criteria, or cytogenetics. All patients achieved remission criteria (defined as ≤2 cm adenopathy, absence of splenomegaly, ≤20% of the intertrabecular space involved on BM biopsy) before BMT. Despite the use of fludarabine, a median of three treatment regimens were required to achieve BMT eligibility. After BMT, all patients achieved complete hematologic engraftment. Toxicities were not significantly different between autologous versus allogeneic BMT. Two toxic deaths were observed. Of 19 evaluable patients, 17 clinical complete clinical remissions (89%) were observed, with 2 patients (1 allogeneic and 1 autologous) exhibiting persistent BM disease. Complete clinical remissions were documented at the phenotypic and molecular level for the majority of patients in whom dual fluorescence for CD5 and CD20 (15 of 15; 100%) and Ig gene rearrangements (11 of 14; 79%) were performed. Although long-term follow-up is needed to assess any potential impact on the disease-free and overall survival of these patients, this study shows the feasibility of using high-dose chemoradiotherapy and BMT in patients with poor prognosis B-CLL.

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