What is the role of allogeneic stem cell transplantation in CLL in the light of novel drugs?

John Gribben, MD, DSc, FRCPath, FMed Sci of Barts Cancer Institute, London, UK discusses the place of allogeneic stem cell transplantation in chronic lymphocytic leukemia (CLL) at the 2016 International Workshop of the German CLL Study Group (GCLLSG) in Cologne, Germany. Prof. Gribben points out that allogeneic stem cell transplantation is the only curative treatment available in CLL. However, only a small population of patients can receive a transplant due to age and it is associated with morbidity (specifically from graft-versus-host-disease) and mortality. When the choice was between a transplant or having no effective salvage therapy, the decision was more clear-cut. With the advent of new drugs with high response rates and good duration of response as well as toxicity profiles, it is becoming less clear where an allogeneic stem cell transplant fits into the management of CLL. There are guidelines available but there is no clear consensus and no sufficient data on this question. As Prof. Gribben explains, it is important not to miss the window in which a transplant would be useful. Finally, Prof. discusses how with idelalisib, ibrutinib and venetoclax now available to salvage the high-risk patients, the transplant is again moved further back in the treatment of CLL.

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