Indications for allogeneic stem cell transplantation in chronic lymphocytic leukemia: the EBMT transplant consensus.
The aim of this project was to identify situations where allogeneic stem cell transplantation (allo-SCT) might be considered as a preferred treatment option for patients with B-cell chronic lymphocytic leukemia (CLL). Based on a MEDLINE search and additional sources, a consented proposal was drafted, refined and approved upon final discussion by an international expert panel. Key elements of the consensus are (1) allo-SCT is a procedure with evidence-based efficacy in poor-risk CLL; (2) although definition of 'poor-risk CLL' requires further investigation, allo-SCT is a reasonable treatment option for younger patients with (i) non-response or early relapse (within 12 months) after purine analogues, (ii) relapse within 24 months after having achieved a response with purine-analogue-based combination therapy or autologous transplantation, and (iii) patients with p53 abnormalities requiring treatment; and (3) optimum transplant strategies may vary according to distinct clinical situations and should be defined in prospective trials. This is the first attempt to define standard indications for allo-SCT in CLL. Nevertheless, whenever possible, allo-SCT should be performed within disease-specific prospective clinical protocols in order to continuously refine transplant indications according to new developments in risk assessment and treatment of CLL.
Dreger
P
P
Department of Medicine V, University of Heidelberg, Heidelberg, Germany. peter.dreger@med.uni-heidelberg.de
Corradini
P
P
Kimby
E
E
Michallet
M
M
Milligan
D
D
Schetelig
J
J
Wiktor-Jedrzejczak
W
W
Niederwieser
D
D
Hallek
M
M
Montserrat
E
E
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019317:Evidence-Based Medicine; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D033581:Stem Cell Transplantation; D013997:Time Factors