ABSTRACT
CLL is an extremely heterogeneous disease, with clinical course varying from patients
who can live with CLL for decades and who never require therapy to those with a rapidly
progressive and fatal malignancy. In addition, most patients with CLL are elderly. This
means that for the vast majority of patients with CLL, hematopoietic stem cell
transplantation (SCT) is not a suitable treatment option. However, younger patients will
die of their disease and are better able to tolerate the toxicities associated with this
approach. In addition, advances in the understanding of the biology of this disease have
led to an increasing ability to identify patients likely to have more rapid disease
progression, (1) and such younger patients are suitable candidates for SCT. Although
encouraging results have been achieved in phase II clinical trials, there have been no
prospective studies evaluating the outcome after SCT compared with conventional
therapy unlike other hematological malignancies where the role of SCT for specific risk
groups has been established in prospective studies (2-8). The biggest challenge remains
identification of which patients with CLL are sufficiently high risk to merit SCT and
when in the course of their disease that SCT should be considered.
