So, what is the conclusion? Who should have a transplant and when. As usual, the best results are achieved in people who don't need one, and transplanters delight in doing these because it makes their results look good. However, all transplants have a risk of killing the patients, and the procedure is not so safe that it should be performed if it is not necessary.
Perhaps the most obvious group to benefit are patients without co-morbidities who need treatment but have del 17p. Even in this group there is probably a need to debulk the disease before the transplant and how to do this is controversial.
The second group is for patients who have failed to respond to a fludarabine containing regimen or relapsed following treatment with one within 12 months.
The only other sensible advice is not to muck around with other regimes like PCR, cladribine or various experimental treatments. If a transplant is necessary it should be performed as soon as the criteria are met.
There is no information about which reduced conditioning regime should be used, but almost certainly a non-ablative treatment is preferable to an ablative one. T depletion is still in the melting pot. Almost certainly it is better to go to an experienced unit that has performed many previous transplants in CLL (not one that has specialised in other diseases).