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LETTER

Allogeneic Bone Marrow Transplantation in Chronic Lymphocytic Leukemia

Fred Rosner, MD

1 November 1996 | Volume 125 Issue 9 | Page 780

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TO THE EDITOR:

I question the propriety of bone marrow transplantation in patients with chronic lymphocytic leukemia (CLL) in Rai stages 0, 1, or 2 who may be asymptomatic for years without any specific treatment. As reported by Michallet and colleagues [1], 23 of the 54 transplant recipients had disease in Rai stage 0, 1, and 2 at the time of transplantation. Nonetheless, 25 (46%) died of treatment-related complications. How can one justify such a risk–benefit ratio? Although Rai stage 3 or 4 disease is associated with a relatively short median survival, this is not the case for early-stage CLL, in which the prognosis is often good for many years. Michallet and colleagues' Table 1 indicates that 10 of the 23 patients with Rai stage 0, 1, and 2 disease died of complications related to bone marrow transplantation, an unacceptably high mortality rate for a disease that is otherwise indolent until it reaches stage 3 or 4.

What type of informed consent was obtained from these patients? Were they apprised of the possible lethality of bone marrow transplantation? Did the ethics committees at the various institutions approve of this procedure for patients with early-stage CCL? I am deeply troubled by the report of Michallet and colleagues and somewhat surprised that these concerns were not raised by the reviewers of the manuscript or by the editors of Annals.

Author and Article Information

Top Author & Article Info REFERENCE

Mt. Sinai School of Medicine New York, NY 10029.

REFERENCE

Top Author & Article Info REFERENCE

1. Michallet M, Archimbaud E, Bandini G, Rowlings PA, Deeg HJ, Gahrton G, et al. HLA-identical sibling bone marrow transplantation in younger patients with chronic lymphocytic leukemia. Ann Intern Med. 1996; 124:311-5.

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