Dr. Bociek on Reserving Allo-SCT for Certain Patients with CLL

R. Gregory Bociek, MD, an associate professor of internal medicine, Division of Oncology and Hematology and program director, Hematology/Oncology Fellowship Program, University of Nebraska Medical Center, discusses the rationale to reserve allogeneic stem cell transplant (allo-SCT) for certain patients with chronic lymphocytic leukemia (CLL).

Currently, the only patients with CLL who are considered for allo-SCT are those who are young, fit, and have progressed on multiple lines of therapy, such as BTK inhibitors and venetoclax (Venclexta), says Bociek. In these scenarios, patients would have to have a fully matched donor or a sibling donor, Bociek explains. Moreover, moving forward with transplant requires significant discussion with the patient. However, in these rare cases, allo-SCT may be optimal, especially because CAR T-cell therapy is not as developed as it is in diffuse large B-cell lymphoma and mantle cell lymphoma, explains Bociek.

Despite the risk of transplant-related complications or death, young patients with CLL may not have sufficient treatment options available to derive 2 to 4 years of disease-free survival, Bociek says. Although the majority of patients with CLL are older, younger patients could be considered for allo-SCT, concludes Bociek.