Stem cell transplantation for chronic lymphocytic leukemia: should not more patients get a transplant?

Abstract

Summary:Novel therapeutic approaches with conventional chemotherapy and monoclonal antibody combinations have improved the complete remission rates in chronic lymphocytic leukemia. However, cure remains elusive, particularly in fludarabine-refractory patients, whose prognosis remains poor. Autologous stem cell transplantation (SCT) has been explored for such patients, lengthening the time to treatment failure in selected patients, but there is little hope that it will improve the cure rate. The strategy is particularly ineffective in patients with poor biological prognostic factors, such as abnormal cytogenetics and unmutated immunoglobulin heavy-chain variable region. Allogeneic SCT remains the only curative approach, producing an extended disease-free survival in 25-60%, mainly via the graft-versus-leukemia effect. The treatment-related mortality with such an approach has been significant, however, with a 30-40% risk of death within 100 days of the transplant. Nonmyeloablative (NMA) conditioning regimens may produce high response rates and lower morbidity, especially for patients with chemosensitive disease. Randomized trials designed according to the new biologic prognostic parameters described in chronic lymphocytic leukemia are required to better define the role of NMA SCT in the near future.

Early treatment‐related mortality in adult autologous stem cell transplant recipients: a nation‐wide survey of 1482 transplanted patients

“…The most common current indications for ASCT include multiple myeloma (MM) and non‐Hodgkin's lymphoma NHL (1). Interest to perform ASCTs has recently increased in chronic lymphocytic leukaemia (CLL) (2–4) and AL amyloidosis (5, 6), whereas it has declined in breast cancer (BC) (1).…”

Chronic Lymphocytic Leukemia: New Concepts and Emerging Therapies

“…However, most trials are limited by size, absence of long-term follow up and high treatment-related mortality [81]. In addition, no true consensus has been formed as to how best identify appropriate candidates.…”

Reduced-Intensity Regimens in Allogeneic Stem-Cell Transplantation for Non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia

“…29 A 6-year PFS rate of 30% was also recently reported from the Dana Farber Cancer Center, 30 where investigators studied patients early in the course of their disease, with a low tumor burden after in vitro purging with a cocktail of anti-B cell antibodies. Most patients had an unmutated immunoglobulin variable heavychain gene, by retrospective analysis.…”