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the mutated IGHV gene.
After a median follow-up
of 12.8 years, PFS was 30.9
percent among all patients
(median PFS=6.4 years);
for patients with the IGHV
mutation, though, PFS was
53.9 percent and those with
unmutated IGHV had a PFS
of 8.7 percent.
Half (50.7%) of the patients who achieved MRDnegativity post-treatment
had the IGHV mutation,
with a PFS of 70.9 percent.
IGHV-mutated patients
with MRD-negativity also
had superior long-term
survival (87.2% vs. 56.5%;
p=0.003). “The high rate
of very long-term PFS in
patients with mutated IGHV
after FCR argues for the
continued use of chemoimmunotherapy in this patient
subgroup,” the researchers
concluded.
Dr. Thompson and
colleagues also identified
a plateau for patients with
mutated IGHV, finding
no relapses beyond 10.4
years in 42 patients. “The
existence of PFS plateaus
in mutated IGHV patients
treated with FCR raises
the prospect that many
of these patients may be
cured of their CLL,” the
authors wrote. “Further
follow-up of the patients in
this plateau in the coming
years, as well as systematic
testing of all patients for
MRD, is planned to determine whether this prospect
is indeed a reality.”
The researchers
noted two limitations of the
study: Standard response
assessment was based on
clinical criteria rather than
the results of computed
tomography scans, and
the patient population was
younger and, therefore,
more likely to have earlystage CLL. ●
REFERENCES
Fischer K, Bahlo J, Fink AM, et al. Long term
remissions after FCR chemoimmunotherapy in
previously untreated patients with CLL: updated
results of the CLL8 trial. Blood. 2015 October 20.
[Epub ahead of print]
Thompson PA, Tam CS, O’Brien SM, et al.
Fludarabine, cyclophosphamide and rituximab
achieves long-term disease-free survival in IGHVmutated chronic lymphocytic leukemia. Blood.
2015 October 22. [Epub ahead of print]
Prioritizing Unrelated Donor Characteristics in Allogeneic Transplants
How Do Age, HLA Disparity Affect Survival?
The number of adults registered
as unrelated donors for hematopoietic stem cell transplantation
has topped 24 million worldwide,
and that number is still increasing. Given the large number of
unrelated-donor transplantations,
it is important to understand which
donor characteristics are associated
with better survival in patients with
hematologic malignancies.
“While there is agreement that
donor–recipient HLA-match is
an important criterion and that
HLA-matching should consider
allele-level HLA-match, strategies vary when prioritizing among
comparably HLA-matched potential
donors,” Craig Kollman, PhD, from
the Jaeb Center for Health Research
in Tampa, Florida, and colleagues
wrote in a study recently published
in Blood. “With increasing numbers
of transplantations being performed
with grafts from adult unrelated
donors, it is critical to identify donor
characteristics associated with survival after transplantation after adjusting for relevant patient, disease,
and transplantation characteristics.”
Characteristics of Patients, Their Donors,
and Transplantation
Dr. Kollman and co-authors
analyzed the following donor characteristics on survival, hematopoietic recovery, and graft-versus-host
disease (GVHD) in donors and recipients with allele-level HLA typing
at HLA-A, -B, -C, and -DBR1:
• Age
• Sex
• Parity
• Cytomegalovirus serostatus
• HLA-match
• ABO blood group match
Data were collected from the
Center for International Blood and
Marrow Transplant Research, a
network of more than 450 transplant centers worldwide, including
information on patient, disease,
and transplantation characteristics. Patients who had previously
received autologous or allogeneic
transplantation, had ex vivo T-cell
depletion, or CD34-selected grafts
were excluded from the study.
Patients inc