REPLY
Allogeneic Bone Marrow Transplantation in Chronic Lymphocytic Leukemia
Mauricette Michallet, MD;
Philip A. Rowlings, MB, BS; and
Ciril Rozman, MD
1 November 1996 | Volume 125 Issue 9 | Page 780
IN RESPONSE:
We agree that most persons with CLL in Rai stage 0 to 2 have a good prognosis with conventional therapies and should not have bone marrow transplantation because of its treatment-related risks. Several of our co-authors expressed their agreement with this view in previous papers [1-3]. The International Bone Marrow Transplant Registry and European Group for Blood and Marrow Transplantation require participating institutions to report all consecutive transplant recipients and their outcome; they do not prescribe who should be treated or how transplantation should be done. Indications for transplantation (and standards for informed consent) are established by each transplantation center and its governing bodies. Most of the persons in our study with disease in Rai stage 0 to 2 before transplantation had the procedure more than 1 year after diagnosis (median, 25 months) and had received conventional treatment before transplantation. Consequently, their prognosis differed from that of persons presenting with early-stage CLL. We had no data on why these patients received transplantation nor complete details of their previous therapy. Results of allogeneic transplantations for CLL at M.D. Anderson Hospital are interesting, but it is difficult to know whether these results reflect patient selection, a benefit of fludarabine, or other treatment effects. Controlled trials are needed to determine this.
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Author and Article Information
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Hopital Eduouard Herriot Lyon, France, Medical College of Wisconsin Milwaukee, WI 53226, University of Barcelona E-08036 Barcelona, Spain.
1. Montserrat E, Rozman C. Chronic lymphocytic leukemia treatment. Blood Rev. 1993; 7:164-75.
2. Montserrat E, Rozman C. Chronic lymphocytic leukemia: present status. Ann Oncol. 1995; 6:219-35.
3. Rozman C, Montserrat E. Chronic lymphocytic leukemia. N Engl J Med. 1995; 333:1052-7.
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