Although allogeneic hematopoietic cell transplantation (HCT) is currently relegated to later stages of relapsed or refractory chronic lymphocytic leukemia (CLL), novel targeted therapies have altered clinical decision-making for the disease. To address this, an American Society for Blood and Marrow Transplantation (ASBMT) panel of experts has issued recommendations that re-assess the role of allogeneic HCT in CLL.
The ASBMT recommendations include:
|Disease stage||ASBMT recommendation|
|Standard-risk CLL||Allogeneic HCT in the absence of response or if there is evidence of disease progression after BCR inhibitors|
|High-risk CLL||Allogeneic HCT after patients fail 2 lines of therapy and show an objective response to BCR inhibitors or to a clinical trial|
|Richter transformation||Allogeneic HCT upon demonstration of an objective response to anthracycline-based chemotherapy|
Due to a lack of prospective randomized controlled trials comparing allogeneic HCT to novel therapies for treatment of CLL at various disease stages, the CLL experts on the panel developed recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. All recommendations above were graded as strong by the panel.