TO THE EDITOR:
Michallet and colleagues [1] correctly assert that it is unknown how the results collected from the International Bone Marrow Transplant Registry and the European Group for Blood and Marrow Transplantation regarding allogeneic bone marrow transplantation for CLL compare with those of conventional therapies. To answer this question, we studied allogeneic bone marrow and stem-cell transplantation for patients with advanced CLL [2, 3] who failed to respond to fludarabine, an agent considered by many to be the most effective conventional treatment for CLL. These patients usually have a poor prognosis [4]. Sixteen patients had transplantation; 13 were refractory, and 3 had untested relapse after receiving fludarabine. Twelve had Rai stage 4 disease. The incidence of complete remission was 87%. No patients died of acute graft-versus-host disease. Currently, 56% of patients continue to be in remission, as documented by flow cytometry and molecular studies; survivors have been followed for a median of 36 months (range, 3 to 60 months). These data are encouraging, and we believe that allogeneic transplantation is indicated and can be beneficial in this setting.
1. Michallet M, Archimbaud E, Bandini G, Rowlings PA, Deeg HJ, Gahrton G, et al. HLA-identical sibling bone marrow transplantation in younger patients with chronic lymphocytic leukemia. Ann Intern Med. 1996; 124:311-5.
2. Khouri I, Keating MJ, Przepiorka D, van Besien K, Gajewski J, O'Brien S, et al. Stem cell transplantation (SCT) for chronic lymphocytic leukemia (CLL): graft-versus-leukemia (GVL) without acute graft-versus-host-disease [Abstract]. Blood. 1995; 10(Suppl 1):457a.
3. Khouri I, Keating M, Vriesendorp HM, Reading CL, Przepiorka D, Hun YO, et al. Autologous and allogeneic bone marrow transplantation for chronic lymphocytic leukemia: preliminary results. J Clin Oncol. 1994; 12:748-58.
4. Keating MJ, O'Brien S, Kantarjian M, Plunket W, Estey E, Koller C, et al. Long-term follow-up of patients with chronic lymphocytic leukemia treated with fludarabine as a single agent. Blood. 1993; 81:2878-84.
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