Hematopoietic cell transplantation for chronic lymphocytic leukemia

The utilization of hematopoietic cell transplantation (HCT) for the management of patients with chronic lymphocytic leukemia (CLL) has undergone substantial changes over the last decade, especially with the advent of novel therapeutic options including kinase inhibitors. The various new therapeutics including b-cell receptor (BCR; BTK and PI3K), and BCL-2 inhibitors have also demonstrated activity in patients with refractory disease and high-risk features. Given the limited benefit and substantial toxicity of autologous HCT, it is not recommended for routine use in patients with CLL. Moreover, the use of allogeneic HCT should also be limited to appropriate patients with high-risk and progressive disease on BCR or BCL-2 inhibitors. These recommendations are also likely to be modified in the future given the increasing use of combination strategies of these novel agents resulting in deeper and potentially more durable responses and the promising efficacy observed with the use of chimeric antigen receptor cell therapy.