ISSN:
1569-8041
Keywords:
CLL
;
therapy
;
stem-cell transplantation
;
prognosis
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Background:The use of myeloablative intensive therapy followedby autologous or allogeneic stem-cell transplantation (SCT) for treatment ofchronic lymphocytic leukemia (CLL) has largely increased over the last years. Design:The present overview updates the available clinicalresults and discusses important aspects of SCT in patients with CLL includingthe type of SCT (autologous vs. allogeneic), myeloablative regimens, purging,the predictive value of molecular monitoring of residual disease, andprognostic factors for the outcome of transplant approaches. Results:With appropriate supportive care, autologous SCT is safeand can induce long-lasting clinical and molecular remissions, which mayimprove the prognosis of patients with CLL. Feasibiliy and efficacy ofautologous SCT appears to be best early during the course of the disease, butit is still unclear if autotransplantation can cure the disease even in thisfavorable subgroup. The role of purging is still unclear. The better diseasecontrol observed after allografting appears to be due tograft-versus-leukemia activity and may allow cure in at least asubset of poor-risk patients. Due to the extraordinarily hightreatment-related mortality, however, the outcome after allogeneic SCT isstill inferior to that after autologous SCT. Conclusions:Autologous transplantation is a valuable treatmentoption for younger patients with early or sensitive poor-risk CLL. Selectedpatients with advanced poor-risk disease and low probability of successfulauto-SCT should be considered for allografting. However, it must be kept inmind that both autologous and allogeneic stem-cell transplantation are stillexperimental procedures and clinical trials further elucidating their valuein the treatment of patients with CLL are warranted.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1008308510588
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