The role of stem-cell transplantation in chronic lymphocytic leukemia risk-adapted therapy.
Because of the lack of a curative treatment for chronic lymphocytic leukemia (CLL) and the poor prognosis of patients refractory to the newer and more effective therapies for this disease, stem-cell transplantation (SCT) is being increasingly performed in patients with CLL. The available evidence indicates that autologous SCT may prolong survival in highly selected patients, but does not result in cure. Conversely, allogeneic SCT may cure a proportion of patients, including those who are refractory to purine-analog-based therapy or with other unfavorable risk parameters, but at the cost of high morbidity and mortality. Reduced-intensity conditioning (non-myeloablative) regimens may contribute to reducing toxic deaths while preserving the antileukemic effect of the allograft, and results are encouraging in patients with chemosensitive disease. Ongoing randomized studies will hopefully contribute to clarification of the role of SCT in the management of CLL. Meanwhile, SCT in patients with CLL should be performed only within clinical studies.
Giné
Eva
E
Institute of Hematology and Oncology, Department of Hematology Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Villarroel, 170-08036 Barcelona, Spain.
Moreno
Carol
C
Esteve
Jordi
J
Montserrat
Emili
E
D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000601:surgery* / Q000628:therapy; D011379:Prognosis; D011687:Purines / Q000627:therapeutic use; D012306:Risk; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D011687:Purines