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Cwynarski K, van Biezen A, de Wreede L, Stilgenbauer S, Bunjes D, Metzner B, Koza V, Mohty M, Remes K, Russell N, Nagler A, Scholten M, de Witte T, Sureda A, Dreger P. Autologous and Allogeneic Stem-Cell Transplantation for Transformed Chronic Lymphocytic Leukemia (Richter's Syndrome): A Retrospective Analysis From the Chronic Lymphocytic Leukemia Subcommittee of the Chronic Leukemia Working Party and Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2012; 30:2211-7. [DOI: 10.1200/jco.2011.37.4108] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with Richter's syndrome (RS) have a poor prognosis with conventional chemotherapy. The aim of this study was to evaluate the outcome after autologous stem-cell transplantation (autoSCT) or allogeneic stem-cell transplantation (alloSCT) in RS. Patients and Methods A survey was sent to all European Group for Blood and Marrow Transplantation centers assessing transplantations performed for RS. Eligibility criteria included a diagnosis of RS or secondary lymphoma before SCT, age ≥ 18 years, and SCT performed from 1997 to 2007. Data were analyzed by descriptive statistics and methods from survival analysis. Results Fifty-nine patients were registered. Thirty-four patients had received autoSCT, mostly because of chemotherapy-sensitive disease, and 25 had received alloSCT, with 36% being refractory to chemotherapy at SCT. In 18 allograft recipients (72%), reduced-intensity conditioning (RIC) was used. Three-year estimates of the probabilities of overall survival and relapse-free survival (RFS) and the cumulative incidences of relapse and nonrelapse mortality were 36%, 27%, 47%, and 26% for alloSCT and 59%, 45%, 43%, and 12% for autoSCT, respectively. Taking into account the limitations set by the low number of events and age younger than 60 years, chemotherapy-sensitive disease and RIC were found to be associated with superior RFS after alloSCT in multivariate analysis. Factors with a significant impact on autoSCT could not be identified. Conclusion Patients with RS who are sensitive to induction chemotherapy appear to benefit from consolidation with transplantation strategies, and prolonged survival was observed in a proportion of patients.
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Affiliation(s)
- Kate Cwynarski
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Anja van Biezen
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Liesbeth de Wreede
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Stephan Stilgenbauer
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Donald Bunjes
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Bernd Metzner
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Vladimir Koza
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Mohamad Mohty
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Kari Remes
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Nigel Russell
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Arnon Nagler
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Marijke Scholten
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Theo de Witte
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Anna Sureda
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Peter Dreger
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
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