TY - JOUR
T1 - Clinical Practice Recommendations for Use of Allogeneic Hematopoietic Cell Transplantation in Chronic Lymphocytic Leukemia on Behalf of the Guidelines Committee of the American Society for Blood and Marrow Transplantation
AU - Kharfan-Dabaja, Mohamed A.
AU - Kumar, Ambuj
AU - Hamadani, Mehdi
AU - Stilgenbauer, Stephan
AU - Ghia, Paolo
AU - Anasetti, Claudio
AU - Dreger, Peter
AU - Montserrat, Emili
AU - Perales, Miguel Angel
AU - Alyea, Edwin P.
AU - Awan, Farrukh T.
AU - Ayala, Ernesto
AU - Barrientos, Jacqueline C.
AU - Brown, Jennifer R.
AU - Castro, Januario E.
AU - Furman, Richard R.
AU - Gribben, John
AU - Hill, Brian T.
AU - Mohty, Mohamad
AU - Moreno, Carol
AU - O'Brien, Susan
AU - Pavletic, Steven Z.
AU - Pinilla-Ibarz, Javier
AU - Reddy, Nishitha M.
AU - Sorror, Mohamed
AU - Bredeson, Christopher
AU - Carpenter, Paul
AU - Savani, Bipin N.
N1 - Publisher Copyright:
© 2016 The American Society for Blood and Marrow Transplantation
PY - 2016/12/1
Y1 - 2016/12/1
N2 - We sought to establish clinical practice recommendations to redefine the role of allogeneic hematopoietic cell transplantation (allo-HCT) for patients with chronic lymphocytic leukemia (CLL) in an era of highly active targeted therapies. We performed a systematic review to identify prospective randomized controlled trials comparing allo-HCT against novel therapies for treatment of CLL at various disease stages. In the absence of such data, we invited physicians with expertise in allo-HCT and/or CLL to participate in developing these recommendations. We followed the Grading of Recommendations Assessment, Development and Evaluation methodology. For standard-risk CLL we recommend allo-HCT in the absence of response or if there is evidence of disease progression after B cell receptor (BCR) inhibitors. For high-risk CLL an allo-HCT is recommended after failing 2 lines of therapy and showing an objective response to BCR inhibitors or to a clinical trial. It is also recommended for patients who fail to show an objective response or progress after BCR inhibitors and receive BCL-2 inhibitors, regardless of whether an objective response is achieved. For Richter transformation, we recommend allo-HCT upon demonstration of an objective response to anthracycline-based chemotherapy. A reduced-intensity conditioning regimen is recommended whenever indicated. These recommendations highlight the rapidly changing treatment landscape of CLL. Newer therapies have disrupted prior paradigms, and allo-HCT is now relegated to later stages of relapsed or refractory CLL.
AB - We sought to establish clinical practice recommendations to redefine the role of allogeneic hematopoietic cell transplantation (allo-HCT) for patients with chronic lymphocytic leukemia (CLL) in an era of highly active targeted therapies. We performed a systematic review to identify prospective randomized controlled trials comparing allo-HCT against novel therapies for treatment of CLL at various disease stages. In the absence of such data, we invited physicians with expertise in allo-HCT and/or CLL to participate in developing these recommendations. We followed the Grading of Recommendations Assessment, Development and Evaluation methodology. For standard-risk CLL we recommend allo-HCT in the absence of response or if there is evidence of disease progression after B cell receptor (BCR) inhibitors. For high-risk CLL an allo-HCT is recommended after failing 2 lines of therapy and showing an objective response to BCR inhibitors or to a clinical trial. It is also recommended for patients who fail to show an objective response or progress after BCR inhibitors and receive BCL-2 inhibitors, regardless of whether an objective response is achieved. For Richter transformation, we recommend allo-HCT upon demonstration of an objective response to anthracycline-based chemotherapy. A reduced-intensity conditioning regimen is recommended whenever indicated. These recommendations highlight the rapidly changing treatment landscape of CLL. Newer therapies have disrupted prior paradigms, and allo-HCT is now relegated to later stages of relapsed or refractory CLL.
KW - Allogeneic hematopoietic cell transplantation
KW - BCL-2 inhibitors
KW - BCR inhibitors
KW - Chronic lymphocytic leukemia
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U2 - 10.1016/j.bbmt.2016.09.013
DO - 10.1016/j.bbmt.2016.09.013
M3 - Review article
C2 - 27660167
AN - SCOPUS:85003030059
SN - 1083-8791
VL - 22
SP - 2117
EP - 2125
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 12
ER -