In which cases is hematopoietic stem cell transplantation performed for Chronic Lymphocytic Leukemia?
In the case of Chronic Lymphocytic Leukemia (CLL), hematopoietic stem cell transplantation isn't typically considered at the time of diagnosis. After the first round of cancer treatment, if the disease recurs and a second round of treatment (usually a B-cell receptor inhibitor like Ibrutinib) doesn't provide a response, then subsequent treatments (such as a BCL2 inhibitor like Venetoclax) are considered. If these treatments show a positive response, then allogeneic hematopoietic stem cell transplantation may be considered.
Importantly, if there's no response to the third round of treatment, allogeneic hematopoietic stem cell transplantation is generally recommended. Also, in instances where CLL progresses into an aggressive form of malignant lymphoma, known as Richter's transformation, cancer treatment is administered. Despite a response to this treatment, the chance of recurrence is very high. Hence, an allogeneic hematopoietic stem cell transplant is often recommended to decrease this risk.
What are the outcomes of allogeneic hematopoietic stem cell transplantation?
Regrettably, the results of allogeneic hematopoietic stem cell transplantation for Chronic Lymphocytic Leukemia (CLL) have not yet met the desired expectations. According to current reports, the five to six-year progression-free survival rate, which is the likelihood of surviving without the disease recurring, is approximately 36% to 43%. The mortality rate due to complications from the transplant procedure itself varies between 16% to 36%. This variability is due to the inclusion of patients with different prognoses and risk levels in the reported transplant outcomes.
