Bone marrow transplantation for low-grade lymphoma and chronic lymphocytic leukemia

Treatment of low-grade lymphoma and chronic lymphocytic leukemia (CLL) is a challenge for hematologists. The long physical history and the indolent nature of these diseases do not support the choice of aggressive treatment. However, regardless of the initial sensitivity of these diseases to chemotherapy and radiotherapy, relapse is inevitable and, therefore, treatment choice especially for younger patients is a serious decision. Intensive therapy followed by transplantation with purged autologous bone marrow or peripheral blood progenitor cells has been shown to be efficient in low-grade lymphomas. However, long-term follow-up study has shown a continuous pattern of relapses, many of which are due to the reinfusion of malignant cells, as well as a risk for the development of myelodysplasia and acute myeloid leukemia. Allogeneic bone marrow transplantation (BMT) is an attractive, promising alternative approach that eliminates many of these risks. Treatment of CLL with classical chemotherapeutic agents, as well as biological response modifiers has not provided any significant improvement in the long-term outcome and remission duration. Addition of autologous BMT (ABMT) or allogeneic BMT as a consolidation therapy is under study and might be a step toward a potential cure of this disease.