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Bone Marrow Transplant. 2019 Nov 7. doi: 10.1038/s41409-019-0742-7. [Epub ahead of print]

Ibrutinib as a salvage therapy after allogeneic HCT for chronic lymphocytic leukemia.

Author information

1
Hematology Department, Centre Léon Bérard, Lyon, France. mauricette.michallet@lyon.unicancer.fr.
2
Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
3
Hematology Department, Centre Léon Bérard, Lyon, France.
4
EBMT Data Office, Leiden, Netherlands.
5
EBMT, EBMT Lymphoma Working Party, Paris, France.
6
Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
7
Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
8
Department of Hematology and Oncology, Universitaetsklinikum Goettingen, Goettingen, Germany.
9
Department of Hematology, Universitaetsmedizin Greifswald, Greifswald, Germany.
10
Department of Internal Medicine/Hematology, University Medical Center, Maastricht, Netherlands.
11
Hematology Division, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, University of Milano, Milan, Italy.
12
Unit of Blood Diseases and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, Brescia University, ASST Spedali Civili Brescia, Brescia, Italy.
13
Department of Hematology, University Hospital, Basel, Switzerland.
14
Department of Hematology, University Hospital Leuven and KU Leuven, Leuven, Belgium.
15
Department of Hematology, Eberhard Karls University Tuebingen, Tuebingen, Germany.
16
Department of Hematology, Radboud University Medical Centre, Nijmegen, Netherlands.
17
Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
18
Hope Directorate, St. James's Hospital, Dublin, Ireland.
19
Department of Hematology, Clinical Hospital Center Zagreb, Zagreb, Croatia.
20
Department of Hematology, Martin-Luther-Univeristy, Halle, Germany.
21
Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
22
University Hospital Eppendorf, Hamburg, Germany.
23
Department of Hematology, University Hospital Dresden, Dresden, Germany.

Abstract

The purpose of our study is to provide information on safety and efficacy of ibrutinib as salvage treatment after allo-HSCT for CLL. A total of 56 patients were included, 36 (64%) males; median age at transplantation was 48 years (range: 35-64) and the median number of treatment lines prior to transplantation was 3 (1-10). The median time between allo-HSCT and Ibrutinib was 30 months (range: 1-140). Overall, 40 (71%) patients responded to Ibrutinib; 23 (41%) PR, and 17 (30%) CR. At time of ibrutinib initiation, ten patients had active chronic GVHD that resolved under Ibrutinib, whilst a single patient developed limited de novo chronic GVHD on Ibrutinib. Fourteen patients discontinued ibrutinib, four because of toxicity and ten because of disease progression. Overall, 14 patients progressed (median PFS = 24 months) among them 10 died. Two-year OS and PFS probabilities were 72% (95% CI: 52-84) and 50% (95% CI: 32-66), respectively. Patients with late relapse after allo-HSCT (≥24 months) had a better PFS after ibrutinib. Our study shows that ibrutinib can be safely administered for CLL relapse after allo-HSCT, with comparable efficacy to non-transplanted patients with high-risk disease.

PMID:
31700137
DOI:
10.1038/s41409-019-0742-7

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