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Barriers to Proceeding to Reduced-Intensity Allogeneic Stem Cell Transplant in Chronic Lymphocytic Leukemia

Samantha M Jaglowski, Susan Geyer, Nyla A Heerema, Patrick Elder, Diane Scholl, John C Byrd, Steven M Devine and Leslie Andritsos

To identify potential barriers to reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (ASCT) in patients with chronic lymphocytic leukemia (CLL) we performed a retrospective review of patients referred for transplant consultation at our center. Of the 209 patients evaluated, a substantial proportion of patients who were appropriate candidates for RIC-ASCT were unable to attain disease control to proceed (18.3%) with this therapy. Fludarabine resistance at the time of consultation (p=0.026) and the presence of complex karyotype on metaphase cytogenetics (p=0.048) were observed more frequently among patients unable to receive a transplant, suggesting that the timing of transplant evaluation earlier in the course of treatment for high risk genomic patients is critical for being able to incorporate this treatment modality.