Allogeneic transplantation for chronic lymphocytic leukemia

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BlankAllogeneic transplantation for chronic lymphocytic leukemia.

L ti, M Tarnani, P Chiusolo, F Sora, and S Sica

Mediterr J Hematol Infect Dis, January 1, 2010; 2(2): e2010026.

Istituto di Ematologia, Policlinico " A. Gemelli " , Universita' Cattolica del

Sacro Cuore, Rome, Italy.

Even if Chronic lymphocytic leukemia (CLL) often has an indolent behavior with

good responsiveness to cytoreductive treatment, about 20% of the patients, so

called " poor-risk " patients, show an aggressive course and die within a few

years despite early intensive therapies. Criteria for poor-risk disease

according to the European Bone Marrow Transplantation (EBMT) CLL Transplant

Consensus are: purine analogue refractoriness, early relapse after purine

analogue combination therapy, CLL with p53 lesion requiring treatment.Allogeneic

transplant has potential curative role in CLL, however burden with very high

transplant related mortality (TRM) rates of 38-50%. A major advance in reducing

the short-term morbidity and mortality of allogeneic stem cell transplantation

(SCT) has been the introduction of non-myeloablative or reduced intensity

conditioning (RIC) regimens to allow engraftment of allogeneic stem cells. There

is no doubt that the crucial therapeutic principle of allo-SCT in CLL is graft

versus leukemia (GVL) activity.THE MAJOR COMPLICATIONS OF ALLOGENEIC SCT IN CLL

ARE: chronic graft-versus-host-disease (GVHD) affecting quality of life, high

graft rejection and infection rates correlated with preexisting

immunosuppression. Disease relapse remains the major cause of failure after RIC

allo-HCT in CLL patients.Sensitive minimal residual disease (MRD) quantification

has strong prognostic impact after transplant.

PMID: 21415973