Hematopoietic Stem‐Cell Transplantation for B‐Cell Chronic Lymphocytic Leukemia: Current Status

J. Esteve, E. Montserrat
{"title":"Hematopoietic Stem‐Cell Transplantation for B‐Cell Chronic Lymphocytic Leukemia: Current Status","authors":"J. Esteve, E. Montserrat","doi":"10.1046/J.1468-0734.2000.00012.X","DOIUrl":null,"url":null,"abstract":"Although B-cell chronic lymphocytic leukemia CLL) is incurable with standard therapies, important progress has been made in the treatment of this disease. New treatment modalities result in a high proportion of complete responses and a longer disease-free interval, but unfortunately not in a longer survival. Given these facts, as well as the increasing proportion of patients being diagnosed at a younger age, hematopoietic stem-cell transplants are being frequently offered to individuals with CLL. Candidates to be enrolled in transplant trials can be identified on the basis of a number of reliable prognostic factors. However, the role of transplants in the management of CLL patients has not been established in controlled trials. Therefore, such procedures should still be considered experimental in CLL. In the autologous transplantation setting, the mortality associated with the procedure is usually lower than 10% and the status of the disease at the time of transplantation is the most important factor for survival. However, survival plots do not show a plateau and there is a constant pattern of relapses about 50% at 4 years post-transplant), suggesting that autotransplants do not cure CLL. Allogeneic transplants result in a transplant-related mortality ranging from 25% to 50%. In contrast with autologous transplants, however, in most series there is a survival plateau of about 40%; this is probably due, at least in part, to a graft-vs.-CLL effect. As with autologous transplants, the absence of minimal residual disease after transplantation is associated with a longer disease-free interval. The use of nonmyeloablative regimens in allogeneic transplants is appealing, because they could contribute to a decrease in the transplant-related mortality and to an increase in the age limit of transplantable patients. Hopefully, ongoing prospective studies will help to clarify the many issues still pending on the role of transplants in patients suffering from CLL.","PeriodicalId":82483,"journal":{"name":"Reviews in clinical and experimental hematology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1046/J.1468-0734.2000.00012.X","citationCount":"6","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reviews in clinical and experimental hematology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1046/J.1468-0734.2000.00012.X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 6

Abstract

Although B-cell chronic lymphocytic leukemia CLL) is incurable with standard therapies, important progress has been made in the treatment of this disease. New treatment modalities result in a high proportion of complete responses and a longer disease-free interval, but unfortunately not in a longer survival. Given these facts, as well as the increasing proportion of patients being diagnosed at a younger age, hematopoietic stem-cell transplants are being frequently offered to individuals with CLL. Candidates to be enrolled in transplant trials can be identified on the basis of a number of reliable prognostic factors. However, the role of transplants in the management of CLL patients has not been established in controlled trials. Therefore, such procedures should still be considered experimental in CLL. In the autologous transplantation setting, the mortality associated with the procedure is usually lower than 10% and the status of the disease at the time of transplantation is the most important factor for survival. However, survival plots do not show a plateau and there is a constant pattern of relapses about 50% at 4 years post-transplant), suggesting that autotransplants do not cure CLL. Allogeneic transplants result in a transplant-related mortality ranging from 25% to 50%. In contrast with autologous transplants, however, in most series there is a survival plateau of about 40%; this is probably due, at least in part, to a graft-vs.-CLL effect. As with autologous transplants, the absence of minimal residual disease after transplantation is associated with a longer disease-free interval. The use of nonmyeloablative regimens in allogeneic transplants is appealing, because they could contribute to a decrease in the transplant-related mortality and to an increase in the age limit of transplantable patients. Hopefully, ongoing prospective studies will help to clarify the many issues still pending on the role of transplants in patients suffering from CLL.
造血干细胞移植治疗B细胞慢性淋巴细胞白血病:现状
虽然b细胞慢性淋巴细胞白血病(CLL)是无法治愈的标准疗法,重要的进展已经在治疗这种疾病。新的治疗方式导致高比例的完全缓解和更长的无病间隔,但不幸的是,没有更长的生存期。考虑到这些事实,以及越来越多的患者在年轻时被诊断出来,造血干细胞移植经常被提供给CLL患者。可以根据一些可靠的预后因素来确定移植试验的候选人。然而,移植在CLL患者治疗中的作用尚未在对照试验中得到证实。因此,这些程序在CLL中仍应被视为实验性的。在自体移植的情况下,与手术相关的死亡率通常低于10%,移植时的疾病状态是生存的最重要因素。然而,生存图并没有显示出平台期,并且在移植后4年有一个恒定的复发模式(约50%),这表明自体移植并不能治愈CLL。同种异体移植导致与移植相关的死亡率在25%到50%之间。然而,与自体移植相比,在大多数系列中,生存平台约为40%;这可能是由于,至少部分是由于反腐。慢性淋巴细胞白血病效果。与自体移植一样,移植后无最小残留疾病与较长的无病间隔相关。在同种异体移植中使用非清髓方案是有吸引力的,因为它们有助于降低移植相关死亡率并提高可移植患者的年龄限制。希望正在进行的前瞻性研究将有助于澄清关于移植在CLL患者中的作用的许多悬而未决的问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信