CLL-Clear sailing ahead for many, while rough waters remain for some

摘要

Chronic lymphocytic leukemia (CLL) is a common blood cancer where for the 'many' a reasonable survival measured in years to decades with good quality of life can occur [1-3]. However, for the 'few' with poor prognosis [1 ] characterized by features such as sub-optimal response to conventional therapy or presence of high-risk genetic markers such as deletion (del) llq [4] or del 17p [5,6] by FISH testing [7], the outlook is poor, with expected survival in the order of 1 -5 years [8-11 ].The article by Chavez and colleagues [12] in this issue illustrates the challenges faced by such patients even following allogeneic hematopoetic stem cell transplantation (allo HSCT). Prior studies have shown that patients with these two high-risk FISH abnormalities may be cured with allo HSCT [13-16]. Long term results however have varied in different series, with some showing poor results in this patient population despite allo HSCT [17]. It is likely that factors including timing of transplant and co-presence of other poor-risk features account for the fact that some of these patients may achieve cure with transplant, while some will have higher than average risk of mortality related to the transplant (non-relapse mortality, NRM) and/or the CLL. Full analysis of outcomes for these patients, including impact of pre and post transplant factors, is important so that we may modify and improve their treatment algorithm in the future.