Dreger P, Michallet M, Schmitz N
Second Department of Medicine, University of Kiel, Germany.
Ann Oncol. 2000;11 Suppl 1:49-53.
The use of myeloablative intensive therapy followed by autologous or allogeneic stem-cell transplantation (SCT) for treatment of chronic lymphocytic leukemia (CLL) has largely increased over the last years.
The present overview updates the available clinical results and discusses important aspects of SCT in patients with CLL including the type of SCT (autologous vs. allogeneic), myeloablative regimens, purging, the predictive value of molecular monitoring of residual disease, and prognostic factors for the outcome of transplant approaches.
With appropriate supportive care, autologous SCT is safe and can induce long-lasting clinical and molecular remissions, which may improve the prognosis of patients with CLL. Feasibiliy and efficacy of autologous SCT appears to be best early during the course of the disease, but it is still unclear if autotransplantation can cure the disease even in this favorable subgroup. The role of purging is still unclear. The better disease control observed after allografting appears to be due to graft-versus-leukemia activity and may allow cure in at least a subset of poor-risk patients. Due to the extraordinarily high treatment-related mortality, however, the outcome after allogeneic SCT is still inferior to that after autologous SCT.
Autologous transplantation is a valuable treatment option for younger patients with early or sensitive poor-risk CLL. Selected patients with advanced poor-risk disease and low probability of successful auto-SCT should be considered for allografting. However, it must be kept in mind that both autologous and allogeneic stem-cell transplantation are still experimental procedures and clinical trials further elucidating their value in the treatment of patients with CLL are warranted.
在过去几年中，采用清髓性强化治疗后进行自体或异基因干细胞移植（SCT）治疗慢性淋巴细胞白血病（CLL）的情况已大幅增加。
本综述更新了现有的临床结果，并讨论了CLL患者SCT的重要方面，包括SCT的类型（自体与异基因）、清髓方案、净化、残留疾病分子监测的预测价值以及移植方法结果的预后因素。
在适当的支持治疗下，自体SCT是安全的，可诱导持久的临床和分子缓解，这可能改善CLL患者的预后。自体SCT的可行性和疗效似乎在疾病过程早期最佳，但即使在这个有利的亚组中，自体移植是否能治愈该疾病仍不清楚。净化的作用仍不明确。同种异体移植后观察到的更好的疾病控制似乎归因于移植物抗白血病活性，并且可能至少使一部分高危患者得到治愈。然而，由于与治疗相关的死亡率极高，异基因SCT后的结果仍劣于自体SCT后的结果。
自体移植是早期或敏感高危CLL年轻患者的一种有价值的治疗选择。对于晚期高危疾病且自体SCT成功可能性低的选定患者，应考虑进行同种异体移植。然而，必须牢记，自体和异基因干细胞移植仍然是实验性程序，有必要进行进一步阐明其在CLL患者治疗中价值的临床试验。
