Canterbury DHB

Context

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.

Recommended reading

About this Canterbury DHB document (8153):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

December 2016

Next Review:

December 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 8153