Allogeneic HSCT for CML

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Allogeneic HSCT for CML
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CLL Subcommittee core activities 2006
Study Design PI auto-SCT (1) randomized-ph3
M Michallet p53 (2) retrospective J
Schetelig Unrelated retrospective M
Michallet donors Transplant
(3) guideline P Dreger consensus
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(1) CLL auto trial Now 200 patients
randomized! Planned 1st interim analysis
currently underway
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(2) p53 project
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(3) EBMT CLL Transplant Consensus

• allo-SCT is a reasonable treatment option in
• poor-risk CLL
• Non-response or early relapse (lt12 mths) after
  purine analogue-based therapy ( fludarabine
  resistance)
• Relapse lt24 mths after purine analogue
  combinations or auto-SCT ( high-risk genetics)
• p53 mutation with treatment indication

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EBMT CLL subcommittee
















Chair
Principal Investigator
P Dreger
M Michallet
Core Members
R Brand
P Corradini
J Esteve
E Kimby
D Niederwieser
D Milligan
E Montserrat
J Schetelig
D Soligo
W Wiktor-Jedrzejczak
S Richards
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Definition of Transplantation-Associated
Microangiopathy (TAM) by the International
Working Group

• All of the following present
• Increased percentage (gt4) of schistocytes in
  peripheral blood
• De novo, prolonged or progressive
  thrombocytopenia (platelet count less than
  50x109/L or a 50 or greater decrease from
  previous counts)
• Sudden and persistent increase in LDH
• Decrease in hemoglobin concentration or increased
  red blood cell transfusion requirement
• Decrease in serum haptoglobin concentration

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Cumulative incidence estimates from a competing
risk analysis for MDS/sAL patients above 50 years
of age transplanted with a HLA-id sibling donor
1997-2000
1993-1996
REL
REL
NRM
NRM
gt 2000
REL
NRM
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Cumulative incidence estimates from a competing
risk analysis for MDS/sAL patients above 50 years
of age transplanted with an matched unrelated
donor
1993-1996
1997-2000
No plot possible due to low nrs.
REL
NRM
gt 2000
REL
NRM
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Cumulative incidence estimates from a competing
risk analysis for MDS/sAL patients above 50 years
of age transplanted with a HLA-id sibling donor
50-60 years
60 years
REL
REL
STANDARD CONDITIONING
NRM
NRM
REL
REDUCED CONDITIONING
REL
NRM
NRM
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Cumulative incidence estimates from a competing
risk analysis for MDS/sAL patients above 50 years
of age transplanted with an matched unrelated
donor
50-60 years
60 years
STANDARD CONDITIONING
REL
REL
NRM
NRM
REDUCED CONDITIONING
REL
REL
NRM
NRM
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Overview allogeneic transplants in MM
Conditioning (period 1997-2005)N3115
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Multiple myeloma Allogeneic transplantation
RIC versus StandardChanges in OS with Year of
Transplant
Crawley BMT 200535S48
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Multiple Myeloma NMAM 2000
Reduced conditioning Allo
versus Auto
Diagnosis

VAD x 4
SibDonAvailable
SibDonNotAvailable
Responsive
N 364
Autologous transplantation
N364
(Pending 31)
TRM 1 pat
Reduced cond allotranspl
Autologous transpl
N227
N106
Dead 11
Dead 14 TRM 7 (6.6)