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Kronik Lenfositik Lösemi’de Allojeneik Kök Hücre Nakli Deneyimi

Yıl 2018, Cilt: 71 Sayı: 1, 43 - 46, 16.10.2018

Erden Atilla

Öz

Amaç: Kronik lenfositik lösemi (KLL) erișkinlerde en sık görülen lösemidir. Tedavi seçeneği kısıtlıkötü prognozu olan hastalarda, allojeneik kök hücre nakli (AKHN) tedavi alternatifidir. KLL’de allojeneik nakil; tedaviye yanıtısız veya pürin analogları sonrasında erken nükste (12 aydan kısa), pürin analogları veya otolog kök hücre nakli ile yanıtaulașmıș hastalarda 24 ay içinde nüks gelișiminde veya p53 anomalisi olanlarda önerilmekteyken günümüzde hedefe yönelik tedavilerin bașarısıyla AKHN endikasyonları güncellenmiștir. Bu çalıșmada, allojeneik kök hücre nakli yapılan KLL hastalarımızın değerlendirilmesi amaçlanmıștır.

Gereç ve Yöntem: 2007-2015 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi Hematoloji Bilim Dalı’nda tanı alan ve sonrasında Kök Nakil Ünitemizde AKHN yapılmıș yüksek riskli 7 KLL hastası retrospektif olarak değerlendirilmiștir.

Bulgular: Nakil sonrası hastalık değerlendirmesinde; 4/7 hastada (%57) tam remisyon, 3/7 hastada (%43) yanıtsızlık gözlenmiștir. Akut graft versus host hastalığı 2/7 (%29)hastada görülürken, 3/7 (%43) hasta kronik graft versus host hastalığı tanısı almıștır. Genel sağkalım 69 aydır (aralık, 19-121 ay).

Sonuç: Yüksek riskli KLL hastalarında AKHN ile uzun süreli ve sürdürülebilir yanıt oranlarına ulașılabilmektedir.

Anahtar Kelimeler

Allojeneik Kök Hücre Nakli Kronik Lenfositik Lösemi

Proje Numarası

-

Kaynakça

  • 1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program (SEER). Cancer Statistics Review: 1975-2010, November 21, 2013.
  • 2. Bazargan A, Tam CS, Keating MJ. Predicting survival in chronic lymphocytic leukemia. Expert Rev Anticancer Ther. 2012; 12:393–403.
  • 3. Chao MP. Treatment challenges in the management of relapsed or refractory nonHodgkin’s lymphoma - novel and emerging therapies. Cancer Manag Res. 2013;5:251-269.
  • 4. Byrd JC, Brown JR, O’Brien S, et al. Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. N Engl J Med. 2014;371:213-223.
  • 5. Furman RR, Sharman JP, Coutre SE, et al. Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. N Engl J Med. 2014; 370:997-1007.
  • 6. Roberts AW, Davids MS, Pagel JM, et al. Targeting BCL2 with venetoclax in relapsed chronic lymphocytic leukemia. N Engl J Med. 2016;374:311-322
  • 7. Stilgenbauer S, Zenz T. Understanding and managing ultra high-risk chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program. 2010;2010:481-488.
  • 8. Kharfan-Dabaja MA, Kumar A, Hamadani M, et al. Clinical practice recommendations for use of allogeneic hematopoietic cell transplantation in chroniclymphocytic leukemia on behalf of the guidelines Committee of the American Society for blood and marrow transplantation. Biol Blood Marrow Transplant. 2016; 22:2117-2125.
  • 9. Sorror ML, Storer BE, Sandmaier BM, et al. Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. J Clin Oncol 2008; 26:4912-4920.
  • 10. Gratwohl A, Stern M, Brand R, et al. Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Cancer. 2009;115: 4715-4726.
  • 11. Hallek M, Cheson BD, Catovsky D et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood. 2008;111:5446-5456.
  • 12. Bacigalupo A, Ballen K, Rizzo D et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood and Marrow Transplant. 2009;15: 1628-1633.
  • 13. Shustik C, Bruckler IB, Delage R, et al. Advances in the treatment of relapsed/refractory chronic lymphocytic leukemia. Ann Hematol. 2017;96:1185-1196.
  • 14. Burger JA, Keating MJ, Wierda WG, et al. Safety and activity of ibrutinib plus rituximab for patients with high-risk chronic lymphocytic leukaemia: a single-arm, phase 2 study. Lancet Oncol, 2014;15:1090-1099.
  • 15. Stilgenbauer S, Eichhorst B, Schetelig J, et al. Venetoclax in relapsed or refractory chronic ymphocytic leukaemia with 17p deletion: a multicentre, open-label, phase 2 study. Lancet Oncol. 2016;17:768-778.
  • 16. Jones J, Choi MY, Mato AR, et al. Venetoclax (VEN) monotherapy for patients with chronic lymphocytic leukemia (CLL) who relapsed after or were refractory to ibrutinib or idelalisib. Blood 2016; 128:637.
  • 17. Shanafelt TD, Borah BJ, Finnes HD, et al. Impact of ibrutinib and idelalisib on the pharmaceutical cost of treating chronic lymphocytic leukemia at the individual and societal levels. J Oncol Pract 2015 ;11:252-258.
  • 18. Jain P, Keating M, Wierda W, et al. Outcomes of patients with chronic lymphocytic leukemia after discontinuing ibrutinib. Blood. 2015;125:2062-2067.
  • 19. Kharfan-Dabaja MA, El-Asmar J., Awan FT, et al. Current state of hematopoietic cell transplantation in CLL as smart therapies emerge. Best Pract Res Clin Haematol. 2016;29:54-66.
  • 20. Brown JR, Kim HT, Armand P, et al. Long-term follow-up of reduced-intensity allogeneic stem cell transplantation for chronic lymphocytic leukemia: prognostic model to predict outcome. Leukemia. 2013 ;27:362-369.
  • 21. Kharfan-Dabaja MA, Moukalled N, Reljic T, et al. Reduced intensitiy is preferred over myeloablative conditioning allogeneic HCT in chronic lymphocytic leukemia whenever indicated: A systemic review/meta-analysis. Hematol Oncol Stem Cell Ther. 2017 Nov 26.
  • 22. Khouri IF, Bassett R, Poindexter N, et al. 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. Cancer. 2011;117:4679-4688.
  • 23. Schetelig J, van Biezen A, Brand R, et al. Allogeneic hematopoietic stem-cell transplantation for chronic lymphocytic leukemia with 17p deletion: a retrospective European Group for Blood and Marrow Transplantation analysis. J Clin Oncol. 2008;26:5094-5100.
  • 24. Khouri IF, Saliba RM, Admirand J, et al. Graft-versus-leukaemia effect after nonmyeloablative haematopoietic transplantation can overcome the unfavourable expression of ZAP-70 in refractory chronic lymphocyte leukaemia. Br J Haematol. 2007;137:355-363.
  • 25. Cwynarski K, van Biezen A, de Wreede L, et al. 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: 2211-2217.
  • 26. van Gelder M, de Wreede LC, Bornhauser M, et al. Long-term survival of patients with CLL after allogeneic transplantation: a report from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2017; 52:372-380.
  • 27. Van Gelder M, Ziagkos D, Wreede L, et al. Baseline Characteristics Predicting Very Good Outcome of Allogeneic Hematopoietic Cell Transplantation in Young Patients With High Cytogenetic Risk Chronic Lymphocytic Leukemia-A Retrospective Analysis From the Chronic Malignancies Working Party of the EBMT. Clin Lymphoma Myeloma Leuk. 2017;17:667-675.
  • 28. Schetelig J, Wreede LC, Gelder van M et al. Risk factors for treatment failure after allogeneic transplantation of patients with CLL: a report from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2017;52: 552-560.

Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia

Yıl 2018, Cilt: 71 Sayı: 1, 43 - 46, 16.10.2018

Erden Atilla

Öz

Objective: Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. In patients with poor prognosis, allogeneic stem cell transplantation (ASCT)treatment is an alternative. ASCT indications in CLL: Patients with refractory disease or early relapse (shorter than 12 months) after treatment with purine analogues, relapse within 24 months after achieving response with purine analogues/autologous stem cell transplantation or in patients with p53 anomalies. However, the indications have been revised after novel therapies reached successful results in relapsed/refractory setting. In this study, we aimed to evaluate our CLL patients who underwent ASCT.

Materials and Methods: Seven high-risk patients with CLL who were diagnosed at Ankara University School of Medicine Department of Hematology between 2007-2015and subsequently underwent ASCT at our Bone Marrow Transplantation Unit were evaluated retrospectively.

Results: In post-transplant disease evaluation, 4/7 patients (57%) achieved complete remission and 3/7 patients (43%) did not respond. Acute graft versus host disease was detected in 2/7 (29%) patients while 3/7 (43%) patients were diagnosed with chronic graft versus host disease. Overall survival was 69 months (range, 19-121 months).

Conclusion: Sustained response rates can be achieved with ASCT in high-risk CLL patients in long-term.

Anahtar Kelimeler

Allogeneic Stem Cell Transplantation Chronic Lymphocytic Leukemia Leukemia

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Kaynakça

  • 1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program (SEER). Cancer Statistics Review: 1975-2010, November 21, 2013.
  • 2. Bazargan A, Tam CS, Keating MJ. Predicting survival in chronic lymphocytic leukemia. Expert Rev Anticancer Ther. 2012; 12:393–403.
  • 3. Chao MP. Treatment challenges in the management of relapsed or refractory nonHodgkin’s lymphoma - novel and emerging therapies. Cancer Manag Res. 2013;5:251-269.
  • 4. Byrd JC, Brown JR, O’Brien S, et al. Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. N Engl J Med. 2014;371:213-223.
  • 5. Furman RR, Sharman JP, Coutre SE, et al. Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. N Engl J Med. 2014; 370:997-1007.
  • 6. Roberts AW, Davids MS, Pagel JM, et al. Targeting BCL2 with venetoclax in relapsed chronic lymphocytic leukemia. N Engl J Med. 2016;374:311-322
  • 7. Stilgenbauer S, Zenz T. Understanding and managing ultra high-risk chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program. 2010;2010:481-488.
  • 8. Kharfan-Dabaja MA, Kumar A, Hamadani M, et al. Clinical practice recommendations for use of allogeneic hematopoietic cell transplantation in chroniclymphocytic leukemia on behalf of the guidelines Committee of the American Society for blood and marrow transplantation. Biol Blood Marrow Transplant. 2016; 22:2117-2125.
  • 9. Sorror ML, Storer BE, Sandmaier BM, et al. Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. J Clin Oncol 2008; 26:4912-4920.
  • 10. Gratwohl A, Stern M, Brand R, et al. Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Cancer. 2009;115: 4715-4726.
  • 11. Hallek M, Cheson BD, Catovsky D et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood. 2008;111:5446-5456.
  • 12. Bacigalupo A, Ballen K, Rizzo D et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood and Marrow Transplant. 2009;15: 1628-1633.
  • 13. Shustik C, Bruckler IB, Delage R, et al. Advances in the treatment of relapsed/refractory chronic lymphocytic leukemia. Ann Hematol. 2017;96:1185-1196.
  • 14. Burger JA, Keating MJ, Wierda WG, et al. Safety and activity of ibrutinib plus rituximab for patients with high-risk chronic lymphocytic leukaemia: a single-arm, phase 2 study. Lancet Oncol, 2014;15:1090-1099.
  • 15. Stilgenbauer S, Eichhorst B, Schetelig J, et al. Venetoclax in relapsed or refractory chronic ymphocytic leukaemia with 17p deletion: a multicentre, open-label, phase 2 study. Lancet Oncol. 2016;17:768-778.
  • 16. Jones J, Choi MY, Mato AR, et al. Venetoclax (VEN) monotherapy for patients with chronic lymphocytic leukemia (CLL) who relapsed after or were refractory to ibrutinib or idelalisib. Blood 2016; 128:637.
  • 17. Shanafelt TD, Borah BJ, Finnes HD, et al. Impact of ibrutinib and idelalisib on the pharmaceutical cost of treating chronic lymphocytic leukemia at the individual and societal levels. J Oncol Pract 2015 ;11:252-258.
  • 18. Jain P, Keating M, Wierda W, et al. Outcomes of patients with chronic lymphocytic leukemia after discontinuing ibrutinib. Blood. 2015;125:2062-2067.
  • 19. Kharfan-Dabaja MA, El-Asmar J., Awan FT, et al. Current state of hematopoietic cell transplantation in CLL as smart therapies emerge. Best Pract Res Clin Haematol. 2016;29:54-66.
  • 20. Brown JR, Kim HT, Armand P, et al. Long-term follow-up of reduced-intensity allogeneic stem cell transplantation for chronic lymphocytic leukemia: prognostic model to predict outcome. Leukemia. 2013 ;27:362-369.
  • 21. Kharfan-Dabaja MA, Moukalled N, Reljic T, et al. Reduced intensitiy is preferred over myeloablative conditioning allogeneic HCT in chronic lymphocytic leukemia whenever indicated: A systemic review/meta-analysis. Hematol Oncol Stem Cell Ther. 2017 Nov 26.
  • 22. Khouri IF, Bassett R, Poindexter N, et al. 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. Cancer. 2011;117:4679-4688.
  • 23. Schetelig J, van Biezen A, Brand R, et al. Allogeneic hematopoietic stem-cell transplantation for chronic lymphocytic leukemia with 17p deletion: a retrospective European Group for Blood and Marrow Transplantation analysis. J Clin Oncol. 2008;26:5094-5100.
  • 24. Khouri IF, Saliba RM, Admirand J, et al. Graft-versus-leukaemia effect after nonmyeloablative haematopoietic transplantation can overcome the unfavourable expression of ZAP-70 in refractory chronic lymphocyte leukaemia. Br J Haematol. 2007;137:355-363.
  • 25. Cwynarski K, van Biezen A, de Wreede L, et al. 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: 2211-2217.
  • 26. van Gelder M, de Wreede LC, Bornhauser M, et al. Long-term survival of patients with CLL after allogeneic transplantation: a report from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2017; 52:372-380.
  • 27. Van Gelder M, Ziagkos D, Wreede L, et al. Baseline Characteristics Predicting Very Good Outcome of Allogeneic Hematopoietic Cell Transplantation in Young Patients With High Cytogenetic Risk Chronic Lymphocytic Leukemia-A Retrospective Analysis From the Chronic Malignancies Working Party of the EBMT. Clin Lymphoma Myeloma Leuk. 2017;17:667-675.
  • 28. Schetelig J, Wreede LC, Gelder van M et al. Risk factors for treatment failure after allogeneic transplantation of patients with CLL: a report from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2017;52: 552-560.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Hematoloji
Bölüm Makaleler
Yazarlar

Erden Atilla

Proje Numarası -
Yayımlanma Tarihi 16 Ekim 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 71 Sayı: 1

Kaynak Göster

APA Atilla, E. (2018). Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 71(1), 43-46.
AMA Atilla E. Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ekim 2018;71(1):43-46.
Chicago Atilla, Erden. “Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71, sy. 1 (Ekim 2018): 43-46.
EndNote Atilla E (01 Ekim 2018) Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71 1 43–46.
IEEE E. Atilla, “Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 71, sy. 1, ss. 43–46, 2018.
ISNAD Atilla, Erden. “Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71/1 (Ekim 2018), 43-46.
JAMA Atilla E. Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71:43–46.
MLA Atilla, Erden. “Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 71, sy. 1, 2018, ss. 43-46.
Vancouver Atilla E. Allogeneic Stem Cell Transplantation Experience in Chronic Lymphocytic Leukemia. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71(1):43-6.
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