Chronic Lymphocytic Leukaemia

High risk patients (unfavourable cytogenetics; early relapse; primary refractory disease) treated with conventional therapy typically have short PFS and <20% 4 year survival. Only allogeneic transplant has been shown to be curative. A graft-versus-leukaemia effect is evident after DLI in CLL and low-grade lymphoma and although the TRM after myelo-ablative conditioning is high (38-50%) a plateau in the survival curve is seen after 2 years. For this reason reduced-intensity conditioned allogeneic stem cell transplantation (RICT) has become more popular in recent years. Several reviews of this subject have recently been published (Dreger, Corradini et al. 2007; Delgado, Milligan et al. 2009; Tam and Khouri 2009). Long term progression free survival of 30-60% and 15-25% transplant-related mortality is reported after RICT and outcomes are similar in patients with or without fludarabine-refractory disease or del(17p). Active or unresponsive disease at transplant remains a poor prognostic factor.

Recommendations for choosing CLL patients suitable for allogeneic transplantation have recently been made by the European Bone Marrow Transplantation (EBMT) group and by experts in in the field (Dreger, Corradini et al. 2007; Gribben 2008; Delgado, Milligan et al. 2009; Tam and Khouri 2009). Patients for whom allogeneic transplantation was considered appropriate were those with

Autologous SCT has been followed by high rates of secondary acute leukaemia and is not performed outside clinical trials.

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About this Canterbury DHB document (8153):
Document Owner:	Andrew Butler (see Who's Who)
Last Reviewed:	December 2016
Next Review:	December 2018
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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