title: Current state of hematopoietic cell transplantation in CLL as smart therapies emerge.
abstract: Novel therapies targeting various kinases downstream of the B-cell receptor have emerged along with monoclonal antibodies and BCL-2 antagonists, and are changing the therapeutic landscape of chronic lymphocytic leukemia. However, cure remains unattainable unless eligible patients are offered an allogeneic hematopoietic cell transplant. Access to allogeneic hematopoietic cell transplantation has expanded considerably with availability of reduced intensity conditioning regimens which is capable offering durable remissions even in poor-risk disease. Encouraging data from ibrutinib and venetoclax in Del17p is challenging the notion of disease eradication as the ultimate therapeutic goal to a new concept of merely disease control. By favoring the non-transplant approach, patients should be aware that there are no established salvage therapies, yet, to rescue disease progression after ibrutinib. When disease eradication is the desirable approach, a reduced intensity conditioning allogeneic hematopoietic cell transplant is the preferred choice at this time.
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL, USA. Electronic address: Mohamed.Kharfan-Dabaja@Moffitt.org.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Kharfan-Dabaja
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: El-Asmar
authors.affiliation: Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
authors.forename: Farrukh T
authors.initials: FT
authors.lastname: Awan
authors.affiliation: Department of Medicine and Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL, USA.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Ayala
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives; D064591:Allografts; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D019086:Bridged Bicyclo Compounds, Heterocyclic / Q000627:therapeutic use*; D002872:Chromosome Deletion; D002886:Chromosomes, Human, Pair 17; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000235:genetics / Q000378:metabolism / Q000628:therapy*; D010880:Piperidines; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000037:antagonists & inhibitors; D011720:Pyrazoles / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D058496:Smith-Magenis Syndrome; D013449:Sulfonamides / Q000627:therapeutic use*
chemical_list: D000911:Antibodies, Monoclonal; D000912:Antibodies, Neoplasm; C000595707:BCL2 protein, human; D019086:Bridged Bicyclo Compounds, Heterocyclic; D010880:Piperidines; D019253:Proto-Oncogene Proteins c-bcl-2; D011720:Pyrazoles; D011743:Pyrimidines; D013449:Sulfonamides; C551803:ibrutinib; D000225:Adenine; C579720:venetoclax
keywords: Allogeneic hematopoietic cell transplantation; B-cell receptor inhibitors; Reduced intensity conditioning