The European landscape on allogeneic haematopoeietic cell transplantation in Chronic Lymphocytic Leukaemia between 2009 and 2019: a perspective from the Chronic Malignancies Working Party of the EBMT.
Olivier Tournilhac
(1)
,
Michel van Gelder
(2)
,
Dirk-Jan Eikema
(3)
,
Nienke Zinger
(3)
,
Peter Dreger
(4)
,
Martin Bornhäuser
(5)
,
Vladan Vucinic
,
Christof Scheid
(6)
,
Jan J. Cornelissen
(7)
,
Thomas Schroeder
(8)
,
Pavel Jindra
(9)
,
Henrik Sengeloev
(10)
,
Stephanie Nguyen Quoc
(11)
,
Matthias Stelljes
(12)
,
Igor Wolfgang Blau
(13)
,
Jiri Mayer
(14)
,
Shankara Paneesha
(15)
,
Patrice Chevallier
(16)
,
Edouard Forcade
(17)
,
Nicolaus Kröger
(12)
,
Didier Blaise
(18)
,
John Gribben
(19)
,
Bendt Nielsen
(20)
,
Jan-Erik Johansson
(21)
,
Charalampia Kyriakou
(19)
,
Yves Beguin
(22)
,
Pietro Pioltelli
(23)
,
Antònia Sampol
,
Donal P. Mclornan
(19)
,
Johannes Schetelig
(24)
,
Patrick J. Hayden
(25)
,
Ibrahim Yakoub-Agha
(26)
1
CHU Estaing [Clermont-Ferrand]
2 MUMC - Maastricht University Medical Centre
3 LUMC - Leiden University Medical Center
4 Universität Heidelberg [Heidelberg] = Heidelberg University
5 TU Dresden - Technische Universität Dresden = Dresden University of Technology
6 University Hospital of Cologne [Cologne]
7 Erasmus MC - Erasmus University Medical Center [Rotterdam]
8 University Children's Hospital of Essen
9 First Faculty of Medicine Charles University
10 Rigshospitalet [Copenhagen]
11 CHU Pitié-Salpêtrière [AP-HP]
12 University Hospital Hamburg-Eppendorf
13 Charité - UniversitätsMedizin = Berlin University Medicine
14 University Hospital Brno
15 University Hospitals Birmingham [Birmingham, Royaume-Uni]
16 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
17 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
18 AMU - Aix Marseille Université
19 UCLH - University College London Hospitals NHS Foundation Trust [London, UK]
20 Aarhus University Hospital
21 Sahlgrenska University Hospital [Gothenburg]
22 CHU-Liège - Centre Hospitalier Universitaire de Liège
23 Fondazione MBBM-Ospedale [Monza, Italie]
24 University Hospital Carl Gustav Carus [Dresden, Germany]
25 Trinity College Dublin
26 LIRIC - Lille Inflammation Research International Center - U 995
2 MUMC - Maastricht University Medical Centre
3 LUMC - Leiden University Medical Center
4 Universität Heidelberg [Heidelberg] = Heidelberg University
5 TU Dresden - Technische Universität Dresden = Dresden University of Technology
6 University Hospital of Cologne [Cologne]
7 Erasmus MC - Erasmus University Medical Center [Rotterdam]
8 University Children's Hospital of Essen
9 First Faculty of Medicine Charles University
10 Rigshospitalet [Copenhagen]
11 CHU Pitié-Salpêtrière [AP-HP]
12 University Hospital Hamburg-Eppendorf
13 Charité - UniversitätsMedizin = Berlin University Medicine
14 University Hospital Brno
15 University Hospitals Birmingham [Birmingham, Royaume-Uni]
16 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
17 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
18 AMU - Aix Marseille Université
19 UCLH - University College London Hospitals NHS Foundation Trust [London, UK]
20 Aarhus University Hospital
21 Sahlgrenska University Hospital [Gothenburg]
22 CHU-Liège - Centre Hospitalier Universitaire de Liège
23 Fondazione MBBM-Ospedale [Monza, Italie]
24 University Hospital Carl Gustav Carus [Dresden, Germany]
25 Trinity College Dublin
26 LIRIC - Lille Inflammation Research International Center - U 995
Résumé
Allogeneic transplantation (allo-HCT) is a curative treatment in CLL whose efficacy including the most severe forms had led to the 2006 EBMT recommendations. The advent after 2014 of targeted therapies has revolutionized CLL management, allowing prolonged control to patients who have failed immunochemotherapy and/or have TP53 alterations. We analysed the pre COVID pandemic 2009–2019 EBMT registry. The yearly number of allo-HCT raised to 458 in 2011 yet dropped from 2013 onwards to an apparent plateau above 100. Within the 10 countries who were under the EMA for drug approval and performed 83.5% of those procedures, large initial differences were found but the annual number converged to 2–3 per 10 million inhabitants during the 3 most recent years suggesting that allo-HCT remains applied in selected patients. Long-term follow-up on targeted therapies shows that most patients relapse, some early, with risk factors and resistance mechanisms being described. The treatment of patients exposed to both BCL2 and BTK inhibitors and especially those with double refractory disease will become a challenge in which allo-HCT remains a solid option in competition with emerging therapies that have yet to demonstrate their long-term effectiveness.