The Chronic Lymphocytic Leukemia Channel on VJHemOnc is an independent medical education platform, supported with funding from AstraZeneca (Diamond), AbbVie (Platinum), BeOne Medicines (Silver) and Lilly (Silver). Supporters have no influence on the production of content. The levels of sponsorship listed are reflective of the amount of funding given.
EBMT 2025 | The effectiveness of alloSCT after pathway inhibitor treatment in CLL
In this video, Michel van Gelder, MD, PhD, Maastricht University, Maastricht, Netherlands, comments on a retrospective study assessing the effectiveness of allogeneic transplantation (alloSCT) after pathway inhibitor treatment in CLL. Despite the advent of novel targeted agents, namely BTK and BCL2 inhibitors, there is still a role for alloSCT in some patients. However, there is a need to discuss the optimal timing of transplantation, as it is associated with a risk of non-relapse mortality (NRM). This interview took place at the 51st Annual Meeting of the EBMT in Florence, Italy.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript
So, patients with chronic lymphocytic leukemia or CLL are currently treated after chemoimmunotherapy with targeted agents – we call them BTK inhibitors and BCL2 inhibitors. And they were promising for these patients to expand their lifetime, but some of these still get refractory disease or get intolerance for these agents and there is, at this moment, nothing left to do other than an allogeneic transplant in fit patients with low comorbidities...
So, patients with chronic lymphocytic leukemia or CLL are currently treated after chemoimmunotherapy with targeted agents – we call them BTK inhibitors and BCL2 inhibitors. And they were promising for these patients to expand their lifetime, but some of these still get refractory disease or get intolerance for these agents and there is, at this moment, nothing left to do other than an allogeneic transplant in fit patients with low comorbidities. So the transplant numbers are decreasing, but still there are, and we investigated their outcome.
And well, it’s quite the same as in the previous time where we did not have these novel agents, so the outcome is the same, especially the patients with disease which is responsive to their last treatment and the majority of the patients in this study had as a last treatment a BCL2 inhibitor. So these did very well. They did not reach with a median follow-up of three years their median survival. So that’s the good news for these patients.
And well, then there is always the discussion about the timing because allogeneic stem cell transplantation comes up with a non-relapse mortality which in this study was as expected 10-15%. You always pick up the good patients to try to do such a possibly harmful transplant, and well for these patients maybe it’s better to do it when they are responsive to the last novel agent instead of treating them first with an ongoing non-covalent BTK inhibitor, pirtobrutinib, which I think will be available within one or two years. But that median survival is only, what is it, 20 months. So it expands lifetime a bit, but not so long. So if you give it then first after BCL2 and BTK inhibitor, then you get older and older maybe more comorbidities and then maybe some of these patients cannot transplant it anymore. So yeah, the question is, and we have to discuss this with other experts, how to place allotransplant in the CLL field.
And as many know, I guess CAR T-cell is not so effective in CLL at the moment. It’s done only in studies and a few outside studies. So allotransplant, we think, is still a viable option.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
Read more...
