The evolving role of hematopoietic cell transplantation in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) patients with high-risk markers such as del(17p) or those who have relapsed after multiple lines of therapy have a poor prognosis and allogeneic hematopoietic cell transplantation (alloHCT) has historically been the best opportunity for achieving long-term disease control. Recently, several new highly efficacious and well-tolerated small molecules targeting the B cell receptor (BCR) pathway and Bcl-2 have been approved or are in the late stages of development. These new agents are altering therapeutic paradigms in CLL, but unlike with alloHCT, information on long-term disease control is lacking. Here, we provide an overview of the data supporting the use of HCT in CLL and the promising results with the novel agents. We discuss the evolving role of alloHCT for CLL in the novel agent era, including identifying the patients most likely to benefit from transplantation and optimal transplantation timing, as well the use of novel agents in the post-transplantation setting.