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

Mohamed A. Kharfan-Dabaja, Ambuj Kumar, Mehdi Hamadani, Stephan Stilgenbauer, Paolo Ghia, Claudio Anasetti, Peter Dreger, Emili Montserrat, Miguel Angel Perales, Edwin P. Alyea, Farrukh T. Awan, Ernesto Ayala, Jacqueline C. Barrientos, Jennifer R. Brown, Januario E. Castro, Richard R. Furman, John Gribben, Brian T. Hill, Mohamad Mohty, Carol MorenoSusan O'Brien, Steven Z. Pavletic, Javier Pinilla-Ibarz, Nishitha M. Reddy, Mohamed Sorror, Christopher Bredeson, Paul Carpenter, Bipin N. Savani

Research output: Contribution to journalReview article

38 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2117-2125
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Keywords

  • Allogeneic hematopoietic cell transplantation
  • BCL-2 inhibitors
  • BCR inhibitors
  • Chronic lymphocytic leukemia

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Kharfan-Dabaja, M. A., Kumar, A., Hamadani, M., Stilgenbauer, S., Ghia, P., Anasetti, C., Dreger, P., Montserrat, E., Perales, M. A., Alyea, E. P., Awan, F. T., Ayala, E., Barrientos, J. C., Brown, J. R., Castro, J. E., Furman, R. R., Gribben, J., Hill, B. T., Mohty, M., ... Savani, B. N. (2016). 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. Biology of Blood and Marrow Transplantation, 22(12), 2117-2125. https://doi.org/10.1016/j.bbmt.2016.09.013