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Alert Number 230
Date: May 4, 2024
Mini-allo stem cell transplants are still the only therapy with the proven ability to cure CLL. For younger patients with poor prognostic indicators, running out the clock of their natural life span with watchful waiting is not a viable option, and conventional therapy rapidly becomes a slippery slope that gets steeper with each round of therapy. Stem cell transplants are worth considering — and sooner may be better than later.
That said, biting the bullet and stepping up for a mini-allo transplant is no easy matter. Besides the cost and complexity of the process, there is real risk of mortality and the possibility of nasty graft-versus-host-disease (GVHD) to contend with, and the risk of relapse, before patients can hope to reach the promised land of an enduring cure. But the survival statistics of mini-allo transplants have been improving steadily over the years and you would be doing yourself a disservice if you are letting yourself get scared off by outdated information.
And here is additional good news. Latest article in “Blood” describes the block-buster results of a large, late stage, multi-center, double arm, randomized and placebo-controlled clinical trial (that is about as credible as it gets, as far as clinical trial design goes) that compares a new drug against previous standard approaches to control GVHD. The new drug, BDP, not only controlled GVHD but also had a dramatic effect on overall survival. This large patient cohort contained a subset that was particularly at risk of aggressive GVHD because they had less than perfectly matched donors. In this subset the new drug saw a 91% decrease in overall mortality! When was the last time you saw results like that? You can read our review of this important research right here on this website: GVHD - A Pebble in the Transplant Shoe.
Be well,
Chaya
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