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Allogeneic Bone Marrow Transplantation in Chronic Lymphocytic Leukemia
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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.
Fred Rosner, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
