Stem cell transplantation for chronic lymphocytic leukaemia.
Early results of autologous stem cell transplantation (ASCT) in chronic lymphocytic leukaemia (CLL) suggested a significant proportion of patients remained disease-free for years, raising the possibility of cure. More recent studies have shown no evidence of a plateau in the survival curves indicating that, at best, ASCT may only prolong disease-free survival. Problems remain over progenitor cell mobilization and one study has raised anxieties about post-transplant myelodysplasia. The impact of ASCT in CLL will only be properly ascertained in a randomized clinical trial and this in underway in Europe. Initial results of conventional allogeneic transplantation (allo-SCT) were very disappointing, with an unacceptably high mortality, but did show that cure was possible in some patients. The introduction of reduced intensity conditioning has limited the early transplant-related mortality but it remains too early to determine what proportion of patients will be cured. In view of these uncertainties, is important that reduced intensity allo-SCT for CLL is conducted in the context of a clinical trial. Finally, CLL is very heterogeneous condition and great deal more is becoming understood about the prognostic factors. These will become important in allowing patients and their physicians a choice in balancing the risks of various treatment options.
Paneesha
S
S
Specialist Registrar in Haematology, Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK.
Milligan
D W
DW
D018572:Disease-Free Survival; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D033581:Stem Cell Transplantation / Q000379:methods*; D013601:T-Lymphocytes / Q000276:immunology; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous