From the St. Bartholomew's Hospital, Experimental Cancer Medicine Centre, Barts and The London School of Medicine, London, United Kingdom
Author's disclosure of potential conflicts of interest is found at the end of this article.
Address reprint requests to John G. Gribbon, MD, DSc, Consultant Hematologist and Medical Oncologist, St. Bartholomew's Hospital, Experimental Cancer Medicine Centre, Barts and The London School of Medicine, Charterhouse Square, London EC1M 6BQ, United Kingdom; e-mail: john.gribben{at}cancer.org.uk
Overview: Despite advances in treatment, chronic lymphocytic leukemia (CLL) remains incurable with standard therapy. Although many patients with CLL have an indolent clinical course, it is possible to identify patients with high-risk disease. Younger patients with adverse risk factors will die from disease and, therefore, are candidates for clinical trials that use high-dose chemotherapy and immunotherapy using hematopoietic stem cell transplantation. Autologous stem cell transplantation is feasible and has a relatively low treatment-related mortality, but there is a high incidence of subsequent relapse. Myeloablative allogeneic stem cell transplantation is associated with high treatment-related morbidity and mortality but few late relapses. Attempts to exploit the graft, compared with the leukemia effect of allogeneic donor cells but to reduce toxicity, are being explored in studies of reduced intensity conditioning allogeneic stem cell transplantation in CLL. With many potential treatments available, appropriate patient selection and the timing of stem cell transplantation in the management of CLL remain a controversial focus of ongoing clinical trials. The use of hematopoietic stem cell transplantation must always be weighed against the risk of the underlying disease, and, when considering a patient for transplantation, it is important to note that outcomes are improving with chemoimmunotherapy approaches.
