John Gribben, MD

The aim of this review is to summarize the current knowledge on HSCT in CLL and to discuss critically its role in the age of novel treatment strategies.

Most cases the clinical management of CLL patients with del(17p13.1) poses enormous challenges, and patients should be included in clinical trials whenever possible. However, there are a number of promising novel drugs and immunotherapy strategies under investigation.

The last decade has seen major changes in the treatment of chronic lymphocytic leukemia (CLL), with randomized trials now demonstrating improved survival with the use of chemoimmunotherapy.[1]

One of the greatest challenges facing the physician caring for patients with chronic lymphocytic leukemia (CLL) is the heterogeneity of this disease. Over the past decade, there have been major advances in understanding the pathophysiology of CLL, and in the identification of biomarkers that are helpful to predict the clinical course for individual patients. Over the same period, the available therapeutic options have developed dramatically, exemplified by the introduction of combination therapy with purine analogs and monoclonal antibodies, resulting in significant opportunities to induce complete remission (CR) in CLL patients.

The rationale for graft purging-that infusion of malignant cellscontained within the hematopoieticprogenitor cells (HPC) infusedback to patients who have receivedhigh-dose therapy will contribute torelapse-seems very sound. Whowould willingly be infused with cancercells, and who would ever suggestthat infusion of such cancer cells couldever be thought of as a good idea?Nonetheless, Alvarnas and Forman arecorrect in their conclusion that purginghas never been demonstrated tolead to improved outcome in randomizedtrials.

The indolent lymphomas as a group remain an enigma for both clinicians and pathologists. These malignancies are among the most sensitive to low-dose oral alkylating agents, radiotherapy, and steroids. However, although the overwhelming majority of patients with advanced-stage indolent lymphomas achieve a very good partial remission, far fewer patients achieve lasting complete remission and few, if any, are cured using conventional aggressive combination chemotherapy. This dichotomy between sensitivity to treatment on the one hand, yet incurability on the other has transformed the indolent lymphomas into an area of extremely active research at both the basic molecular level and in clinical trials.