Novel therapeutic approaches with conventional
chemotherapy and
monoclonal antibody combinations have improved the complete remission rates in
chronic lymphocytic leukemia. However, cure remains elusive, particularly in
fludarabine-refractory patients, whose prognosis remains poor. Autologous
stem cell transplantation (SCT) has been explored for such patients, lengthening the
time to treatment failure in selected patients, but there is little hope that it will improve the cure rate. The strategy is particularly ineffective in patients with poor
biological prognostic factors, such as abnormal cytogenetics and unmutated
immunoglobulin heavy-chain variable region. Allogeneic SCT remains the only curative approach, producing an extended disease-free survival in 25-60%, mainly via the graft-versus-
leukemia effect. The treatment-related mortality with such an approach has been significant, however, with a 30-40% risk of death within 100 days of the transplant. Nonmyeloablative (NMA) conditioning regimens may produce high response rates and lower morbidity, especially for patients with chemosensitive disease. Randomized trials designed according to the new
biologic prognostic parameters described in
chronic lymphocytic leukemia are required to better define the role of NMA SCT in the near future.