title: New insights into hematopoietic stem cell transplantation for chronic lymphocytic leukemia: a 2015 perspective.
abstract: A considerable body of evidence demonstrates that allogeneic hematopoietic stem cell transplantation (HSCT) offers the only potentially curative treatment option for patients with chronic lymphocytic leukemia (CLL). However, this approach is suitable for only a minority of CLL patients, owing to its significant treatment-related mortality and morbidity. Until recently, internationally accepted guidelines suggested that HSCT should be considered in physically fit CLL patients who carry poor-risk features, such as TP53 abnormalities, or who had a short response to previous immunochemotherapy. However, several new agents and alternative treatment strategies are available that demonstrate impressive and durable responses, even in CLL patients who previously might have been candidates for transplant. The decision about which patients merit HSCT therefore remains important, and HSCT must now be considered in light of other less toxic therapies. Until data on the long-term efficacy of novel treatment approaches mature, the choice of HSCT vs alternative strategies must be assessed on a patient-by-patient basis, and treatment in the setting of randomized clinical trials should be pursued whenever possible.
authors.affiliation: Barts Cancer Institute of Queen Mary University of London, United Kingdom and German Cancer Research Center, Heidelberg, Germany.
authors.forename: Fabienne
authors.initials: F
authors.lastname: McClanahan
authors.affiliation: Barts Cancer Institute of Queen Mary University of London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Gribben
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D014408:Biomarkers, Tumor; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D058990:Molecular Targeted Therapy; D009017:Morbidity; D009154:Mutation; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000235:genetics / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D016159:Tumor Suppressor Protein p53