Therapeutic decision making in BMT/SCT for chronic lymphatic leukemia

Disease staging page 72 Immune phenotype and cytogenetic abnormalities 72 Cytogenetic findings 73 Prognostic factors 73 Results with conventional therapy 74 Purine analogues 75 Results with fludarabine and rituximab 77 Results with pentostatin and cyclophosphamide 77 Results with alemtuzumab 78 Results with allogeneic transplant 78 Autologous compared with allogeneic stem cell transplantation for poor-risk CLL 78 Nonmyeloablative transplantation for advanced chronic lymphocytic leukemia 79 Predictors of disease-free survival after a nonmyeloablative allogeneic stem cell transplant for advanced chronic lymphocytic leukemia 80 Results with autologous transplant 80 Special problems in transplantation for CLL 81 Indications for transplant 82 HLA-identical sibling transplant 82 Autologous blood/marrow stem cell transplant 83 Contraindications to transplant 83 Pretransplant workup 83 Monitoring posttransplant 83 Further reading 83 Disease staging Immune phenotype and cytogenetic abnormalities 95% B phenotype (typical marker profile surface Ig faint, CD3^–, CD5⁺, CD10^–, CD19⁺, CD20⁺ faint, CD23⁺) 5% T phenotype (these leukemias are no longer considered as chronic lymphatic leukemia [CLL], they are classified as T-lymphoproliferative disorders.) Cytogenetic findings Prognostic factors Patients with CLL have a variable outcome with conventional treatment, ranging from a median survival of 30 to 40 months (Rai stage III–IV, Binet stage C) to >120 months (Rai stage 0, Binet stage A). It is important to consider when contemplating allogeneic transplantation.