A Tool to Select Candidates for Allogeneic Hematopoietic Cell Transplant in CLL but do we need it?

[Jm954]

August 14, 2019

From this it's clear that transplant is not an easy decision to make and the new targeted treatments may have changed the landscape again.

"The past 5 years have seen the introduction of several new treatments that have significantly extended survival rates for patients with chronic lymphocytic leukemia (CLL). Yet, amid the excitement for these new small-molecule inhibitors, researcher Haesook T. Kim, PhD, was concerned that oncologists were discounting allogeneic hematopoietic cell transplantation (HCT) for patients who had failed other options.

“The transplant outcome for CLL patients is actually good, so I wanted the medical community to know that allogeneic transplant is a viable option and can be potentially curative for many CLL patients,” said Dr Kim, principal research scientist at the Dana-Farber Cancer Institute and the Harvard School of Public Health in Boston, Massachusetts.

So Dr Kim set out to see if she could develop a prognostic scoring system that would take into account cytogenetic risk factors and help oncologists determine whether an allogeneic transplant was appropriate for certain patients.

Yet other physicians questioned the study’s usefulness, as Dr Kim analyzed patients who had undergone allogeneic transplants between 2008 and 2014, before the treatment landscape had changed dramatically.

Indeed, transplants are considered a last resort, according to the National Comprehensive Cancer Network’s treatment guidelines. “Prior to the development of small-molecule inhibitors, allogeneic HCT was considered as an effective treatment option for patients with high-risk CLL,” it said, concluding that transplants were no longer a reasonable treatment option for refractory CLL or disease relapse within 2 years after initial purine analogue-based therapy and/or disease with a del(17p) or TP53 mutation.3

“Our patients are doing so well on these new treatments that very few patients are going for transplants these days,” said William Wierda, MD, PhD, CLL section head and center medical director for the department of leukemia at MD Anderson Cancer Center in Houston, Texas. “[Dr Kim’s] study is becoming applicable to fewer and fewer patients.”

More here: cancertherapyadvisor.com/ho...?

Jackie

[81ue]

I hope they keep coming up with drugs that work, the success rate for SCT makes it very high risk indeed.

[sumok]

it's great to have a "last resort" but so much better to develop these new approaches and avoid it. my husband no longer has CLL due to an allo SCT, and we are grateful for his life. it is very much a fact that his *quality* of life post-transplant (4 1/2 years now) is worse than it was with CLL, due to GVHD on various fronts.

[Jm954 Administrator in reply to sumok]

Sumok,

I'm sorry to hear his quality of life post transplant is not as you would have hoped. Sadly that is often the case and easily overlooked. The GVHD is instrumental in curing and keeping the CLL in remission but it's a tricky balance. I hope you both still feel it was worth it.

best wishes

Jackie

[sumok in reply to sumok]

yes, definitely worth it, but there are some dark moments 😔

it's still a work in progress and the doctors are not giving up.

and we have hope; it can resolve at any time.

[avzuclav]

Here's an encouraging update for those of us who end up needing a transplant after novel agents:

Allogeneic hematopoietic cell transplantation after prior targeted therapy for high-risk chronic lymphocytic leukemia

"In summary, despite multiple high-risk features, the clinical outcome of CLL patients who receive targeted therapy prior to transplant is excellent and alloHCT should be offered while the disease is under control."

ashpublications.org/bloodad...