The value of autografting in patients (AGED 15-65) with high risk chronic lymphoncytic leukemia (CLL) A randomised phas

Lead Research Organisation: Heart of England NHS Foundation Trust
Department Name: Clinical Haematology

Abstract

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Guideline Title BCSH Guidelines for the treatment of chronic lymphocytic leukaemia 2013
Description Autografting in chronic lymphocytic leukaemia
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in clinical guidelines
Impact The trial results suggest that autografting may not be more effective than the current best practice of combined immuno-chemotherapy. This has implication commissioners (less investment) and patients (less morbidity)
 
Description MRC CLL Pilot Study of feasibility of peripheral blood stem cell transplantation in CLL 
Organisation European Society for Blood and Marrow Transplantation (EBMT)
Country European Union (EU) 
Sector Charity/Non Profit 
PI Contribution The MRC CLL Pilot Study of feasibility of peripheral blood stem cell transplantation in CLL closed in 2004 and accrued 120 patients, making it the largest European study of autologous transplantation in this condition. Patients were entered by 40 physicians and transplanted in 8 transplant centres in the UK. CLL V was subsequently funded in the UK by the MRC and was run an intergroup study throughout the EBMT. The study closed in 2012 and accrued 223 patients.
Collaborator Contribution MRC CLL V was analysed as part of a planned Intergroup trial with collaborative groups from France, Germany and Switzerland as well as the EBMT. The Royal Marsden Hospital NHS Trust collected the Quality of Life Data and the analysis was conducted by the EBMT Statistical centre at Leiden. Additional statistical support was provided by the CTSU at the University of Oxford. Leeds General Infirmary assisted with diagnostic elements.
Impact The results demonstrated that autografting in CLL is safe and effective however subsequent trials with antibody based therapy have shown equal efficacy at a lower cost. QOL analysis has shown that autografting results in an early diminution of QOL which takes months to improve. Overall the results have discouraged autografting as a standard of care in this condition with substantial healthcare savings. Since publication of the data the number of autografts for CLL in Europe and the US has fallen by >90%.
 
Description MRC CLL Pilot Study of feasibility of peripheral blood stem cell transplantation in CLL 
Organisation Leeds General Infirmary
Country United Kingdom 
Sector Hospitals 
PI Contribution The MRC CLL Pilot Study of feasibility of peripheral blood stem cell transplantation in CLL closed in 2004 and accrued 120 patients, making it the largest European study of autologous transplantation in this condition. Patients were entered by 40 physicians and transplanted in 8 transplant centres in the UK. CLL V was subsequently funded in the UK by the MRC and was run an intergroup study throughout the EBMT. The study closed in 2012 and accrued 223 patients.
Collaborator Contribution MRC CLL V was analysed as part of a planned Intergroup trial with collaborative groups from France, Germany and Switzerland as well as the EBMT. The Royal Marsden Hospital NHS Trust collected the Quality of Life Data and the analysis was conducted by the EBMT Statistical centre at Leiden. Additional statistical support was provided by the CTSU at the University of Oxford. Leeds General Infirmary assisted with diagnostic elements.
Impact The results demonstrated that autografting in CLL is safe and effective however subsequent trials with antibody based therapy have shown equal efficacy at a lower cost. QOL analysis has shown that autografting results in an early diminution of QOL which takes months to improve. Overall the results have discouraged autografting as a standard of care in this condition with substantial healthcare savings. Since publication of the data the number of autografts for CLL in Europe and the US has fallen by >90%.
 
Description MRC CLL Pilot Study of feasibility of peripheral blood stem cell transplantation in CLL 
Organisation Royal Marsden NHS Foundation Trust
Country United Kingdom 
Sector Public 
PI Contribution The MRC CLL Pilot Study of feasibility of peripheral blood stem cell transplantation in CLL closed in 2004 and accrued 120 patients, making it the largest European study of autologous transplantation in this condition. Patients were entered by 40 physicians and transplanted in 8 transplant centres in the UK. CLL V was subsequently funded in the UK by the MRC and was run an intergroup study throughout the EBMT. The study closed in 2012 and accrued 223 patients.
Collaborator Contribution MRC CLL V was analysed as part of a planned Intergroup trial with collaborative groups from France, Germany and Switzerland as well as the EBMT. The Royal Marsden Hospital NHS Trust collected the Quality of Life Data and the analysis was conducted by the EBMT Statistical centre at Leiden. Additional statistical support was provided by the CTSU at the University of Oxford. Leeds General Infirmary assisted with diagnostic elements.
Impact The results demonstrated that autografting in CLL is safe and effective however subsequent trials with antibody based therapy have shown equal efficacy at a lower cost. QOL analysis has shown that autografting results in an early diminution of QOL which takes months to improve. Overall the results have discouraged autografting as a standard of care in this condition with substantial healthcare savings. Since publication of the data the number of autografts for CLL in Europe and the US has fallen by >90%.
 
Description MRC CLL Pilot Study of feasibility of peripheral blood stem cell transplantation in CLL 
Organisation University College Oxford
Country United Kingdom 
Sector Academic/University 
PI Contribution The MRC CLL Pilot Study of feasibility of peripheral blood stem cell transplantation in CLL closed in 2004 and accrued 120 patients, making it the largest European study of autologous transplantation in this condition. Patients were entered by 40 physicians and transplanted in 8 transplant centres in the UK. CLL V was subsequently funded in the UK by the MRC and was run an intergroup study throughout the EBMT. The study closed in 2012 and accrued 223 patients.
Collaborator Contribution MRC CLL V was analysed as part of a planned Intergroup trial with collaborative groups from France, Germany and Switzerland as well as the EBMT. The Royal Marsden Hospital NHS Trust collected the Quality of Life Data and the analysis was conducted by the EBMT Statistical centre at Leiden. Additional statistical support was provided by the CTSU at the University of Oxford. Leeds General Infirmary assisted with diagnostic elements.
Impact The results demonstrated that autografting in CLL is safe and effective however subsequent trials with antibody based therapy have shown equal efficacy at a lower cost. QOL analysis has shown that autografting results in an early diminution of QOL which takes months to improve. Overall the results have discouraged autografting as a standard of care in this condition with substantial healthcare savings. Since publication of the data the number of autografts for CLL in Europe and the US has fallen by >90%.