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Spotlight on Chronic Lymphocytic Leukemia

Autologous and allogeneic stem cell transplantation for chronic lymphocytic leukemia

Leukemia volume 16, pages 985–992 (2002)Cite this article

Abstract

Allogeneic and autologous stem cell transplantation (SCT) are increasingly considered for treatment of patients with chronic lymphocytic leukemia (CLL). In order to assess the potential therapeutic value of SCT for CLL, the present article aims at answering the following crucial questions: (1) Is SCT a curative treatment? (2) Does SCT improve the prognosis of poor-risk CLL? (3) Do risk factors exist which are useful for defining prognostic groups in terms of feasibility and post-transplant outcome? The efficacy of auto-SCT relies exclusively on the cytotoxic therapy administered. To date, there is only limited hope that autotransplantation can cure the disease. Nevertheless, the results of the published series suggest that auto-SCT is capable of improving the prognosis of CLL with poor-risk features. Well defined favorable conditions for successful autografting are the status of the disease (CR or VGPR) and the number of lines of therapy (<2) before transplantation. The crucial anti-leukemic principle of allo-SCT consists in the immune-mediated GVL effects conferred with the graft. The GVL activity explains that allografting seems to be curative for at least a subset of patients. However, as long as allo-SCT in CLL is still associated with an excessively high treatment-related mortality, only selected patients with advanced poor-risk disease should be considered for allografting. The development of conditioning regimens with reduced intensity may allow extending the indications of allogeneic SCT for CLL in the near future.

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Acknowledgements

This work has been performed thanks in part to grants DJCLS 97/NAT-4 and DJCLS-R16, Deutsche José Carreras Leukämie-Stiftung and FISS 99/0189, Generalitat de Catalunya SGR-0025 and 2000XT-025 and José Carreras International Foundation Against Leukemia 01/EM and 00/CR.

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  1. Department of Hematology, AK St Georg, Hamburg, Germany

    P Dreger

  2. Hematology Department, Institute of Hematology and Oncology, Hospital Clinic, University of Barcelona, Barcelona, Spain

    E Montserrat

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Dreger, P., Montserrat, E. Autologous and allogeneic stem cell transplantation for chronic lymphocytic leukemia. Leukemia 16, 985–992 (2002). https://doi.org/10.1038/sj.leu.2402530

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