Oncology Frontier:  What is the role of allogeneic transplantation in patients with chronic lymphocytic leukemia in the era of novel therapies?

　　《肿瘤瞭望》：当前自体造血干细胞移植在慢性淋巴细胞白血病治疗中的地位？

　　Dr Jones: That’s a challenging question because for the majority of patients with genetically high-risk disease (and the group that is at greatest risk is the group with a deletion of chromosome 17p)， their outcomes at two-years after initiation of ibrutinib therapy is still good – more than 50% of them are still in remission. It makes the decision all the more difficult， particularly for those patients who are at the threshold for age or health for the feasibility of allotransplant， to remove them from stable therapy with ibrutinib or another kinase inhibitor to go on to transplant. That said， we know that patients who have deletion 17p CLL are still part of the group that are more likely to relapse. So， the larger answer to your question is that we don’t really know. If the toxicity of transplant was less， I think there would still be recourse to transplant in younger patients who would likely outlive their response to their current therapy， but because there is substantial risk for mortality and a 50% risk of relapse even in initial responders to transplant， most of us have been continuing kinase inhibitor therapy indefinitely rather than sending patients on to transplant. 

　　Jones教授：这是一个很有挑战的问题，因为对于细胞遗传学高危（del（17p））的患者来说，其复发率很高，但应用伊马替尼治疗2年后仍有超过50%的患者处于缓解状态。因此这对于治疗的选择，尤其是在异基因造血干细胞移植年龄阈值左右的患者来说是十分困难的，是选择继续伊马替尼治疗、转为其他TKI，还是进行异基因移植难以决断。如果移植的相关并发症很低，那当然是首选移植，但因为即便患者对移植初始反应良好，也仍然有50%的复发率，所以大部分患者选择继续TKI治疗。