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

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

Correspondence to: P Dreger, AK St Georg, Dept Hematology, Lohmühlenstr. 5, 20099 Hamburg, Germany; Fax: 49 40 2890 4226 or E Montserrat, Dept Hematology, Hospital Clinic, Villaroel 170, 08036 Barcelona, Spain; Fax: 34 93 227 5517

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.

Leukemia (2002) 16, 985-992. DOI: 10.1038/sj/leu/2402530

CLL; stem cell transplantation; review