Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL), the most common leukemia in the Western hemisphere, remains incurable with standard therapies. The increasing use of genetic risk stratification factors, such as cytogenetic abnormalities,00-00 zeta-associated protein 70 (ZAP-70),00-00 and immunoglobulin heavy chain variable region (IgVH) mutational status00-00 allows physicians to identify high-risk patients who likely will fare poorly with standard chemotherapy. CLL patients with unmutated IgVH have a much poorer prognosis than patients with mutated CLL00-00 and comprise a target population for whom SCT should be considered. However, despite considerable interest in the use of SCT for CLL, the long-term survival benefit of SCT remains unclear in this disease. Autologous SCT has failed to demonstrate a durable long-term survival benefit, whereas myeloablative allogeneic SCT is associated with significant treatment-related mortality (TRM). Non-myeloablative allogeneic SCT has demonstrated promise, but long-term follow-up is lacking. The role of SCT in CLL has been extensively reviewed00-00; therefore, this section will focus on selected topics.

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