Chronic lymphocytic leukemia: Allogeneic stem cell transplantation

Abstract

Despite all the progress, chronic lymphocytic leukemia (CLL) remains incurable with standard treatment. Therefore, attention is focused on transplant strategy. Regardless of the encouraging results of autologous stem cell transplantation most patients relapse, in long-term follow-up. In contrast, allogeneic stem cell transplantation (allo-SCT) currently represents the only potentially curative treatment option. The introduction of reducedintensity conditionings (RIC) was able to signifi cantly reduce mortality of allo-SCT, however, relatively high morbidity remains the problem, especially in association with active graft-versus-host disease (GVHD). The defi nition of “poor risk” CLL has been proposed, based on the new knowledge of CLL biology, and after verifi cation of effi cacy of novel therapeutic approaches. This constitutes the framework for basic recommendations for allo-SCT. The signifi cant progress in monitoring of minimal residual disease (MRD) has also been made in recent years. This led to a closer understanding of the graft-versus leukemia (GVL) activity. Simultaneously, monitoring of MRD kinetics can be used for early therapeutic intervention. The space for additional research is represented by the possibility of using a series of cell populations as a form of adoptive immunotherapy. Further reducing of the toxicity and targeted immunotherapy approach are also in focus.