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.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (2016)

Abstract:

Establish clinical practice recommendations to redefine the role of allogeneic HCT for patients with CLL in an era of highly active targeted therapies. We performed a systematic review to identify prospective randomized controlled trials comparing allogeneic HCT against novel therapies for treatment of CLL at various disease stages. In the absence of such data, we invited physicians with expertise in allogeneic HCT and/or CLL to participate in developing these recommendations. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. For standard risk CLL, we recommend allo-HCT in the absence of response or if there is evidence of disease progression after BCR inhibitors. For high-risk CLL, an allogeneic 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 allogeneic 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 allogeneic HCT is now relegated to later stages of relapsed or refractory CLL.