Transplantation in Chronic Lymphocytic Leukemia

Abstract

Article synopsis Allogeneic stem cell transplantation (HSCT) offers the only potentially curative approach to the treatment of chronic lymphocytic leukemia (CLL). However, this is applicable only to a minority of CLL patients in view of the advanced age at presentation. Moreover, HSCT is associated with significant treatment related mortality and morbidity, largely due to chronic graft versus host disease (GVHD). The judicious choice of which patients merit this approach therefore remains important. Internationally accepted guidelines suggest that HSCT is indicated in patients who are fit enough, have a suitable matched donor, have 17p deletion or TP53 mutations or have relapsed relatively quickly after chemo-immunotherapy. There are several new agents that are in clinical trials or recently approved in CLL that demonstrate impressive responses and durable durations of response in high risk patients who might be candidates for transplant. HSCT must always be considered in view of other, potentially less toxic therapies which could be offered. Therefore the choice of HSCT versus a novel agent is one that must be gauged on a patient by patient basis, and this will change as data mature on the use of these novel agents in CLL.