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Transplantation in CLL: what we can learn from a dinosaur

Bone Marrow Transplantation volume 51, pages 765–766 (2016)Cite this article

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The treatment landscape of poor-risk CLL has dramatically changed during the recent 2–3 years with the advent of signal transduction inhibitors (STI), such as the B-cell receptor kinase inhibitors (BCRi) ibrutinib and idelalisib, and the bcl2 inhibitor venetoclax. Whereas ibrutinib and idelalisib are already approved in the United States and Europe for treatment of relapsed/refractory CLL (R/R CLL) and for first-line treatment of genetically high-risk CLL, venetoclax is expected to be labeled for clinical application in patients with CLL in short due. In addition, promising alternative STI as well as second-generation BCRi are under clinical development.1 Despite lacking curative potential when used as monotherapy, all of these drugs have proven high response rates and substantially superior long-term disease control when compared with traditional chemoimmunotherapy (CIT) in CLL, in particular in poor-risk settings as defined by the European Society for Blood and Marrow Transplantation (EBMT) criteria.2 Given this plethora of fascinating novel treatment options, one may wonder if there is any need to study chemoimmunotherapy-based salvage strategies for poor-risk CLL while just having entered the era of chemotherapy-free CLL treatment.

In this issue of BMT, van Gelder and co-workers from the Dutch Study Group for Hemato-Oncology (HOVON) present a prospective clinical trial on the efficacy of dexamethasone, high-dose ara-c, cisplatin (DHAP)-based CIT for bridging patients with high-risk CLL according to the EBMT criteria to hematopoietic stem cell transplantation (HSCT).3 This study was designed and accomplished before ibrutinib and idelalisib became clinically available in Europe, thus testing the investigational CIT salvage regimen as a bridge to HSCT in a strictly STI-free environment. So what can we learn from it in 2016?—A lot.

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Authors and Affiliations

  1. Department of Medicine V, University of Heidelberg, Heidelberg, Germany

    P Dreger

  2. European Society for Blood and Marrow Transplantation (EBMT), Paris, France

    P Dreger

  3. Department of Hematology, Hospital Clínic, University of Barcelona, Barcelona, Spain

    E Montserrat

  4. European Research Initiative on CLL (ERIC), Barcelona, Spain

    E Montserrat

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Correspondence to P Dreger.

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Competing interests

PD is Board member of the European Society for Blood and Marrow Transplantation (EBMT) and the German Working Group for Marrow and Blood Stem Cell Transplantation (DAG-KBT); has worked on Advisory Boards for Janssen, Novartis and Gilead; and has received honoraria from Gilead, Glaxo Smith Kline, Janssen, Novartis and Riemser Pharma. EM declares no conflict of interest.

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Dreger, P., Montserrat, E. Transplantation in CLL: what we can learn from a dinosaur. Bone Marrow Transplant 51, 765–766 (2016). https://doi.org/10.1038/bmt.2016.27

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