Stem cell allografting for chronic Myeloid leukemia in the tyrosine kinase era – forgotten but not gone

Abstract

Due to the remarkable success of tyrosine kinase inhibitors (TKI) in chronic myeloid leukemia (CML), allogeneic stem cell transplantation (alloSCT) is not first-line treatment for delivering durable, long-term survival. Consequently, alloSCT is reserved for patients with TKI-resistant or TKI-intolerant chronic phase CML (CP-CML) and advanced phase CML (AP-CML). Advances in transplant technology, such as high-resolution HLA typing, introduction of reduced intensity conditioning and increased alternative donor availability, coupled with improved supportive care, have significantly reduced transplant-related mortality and expanded the pool of transplant-eligible patients. Refinement of conditioning regimens, innovative use of post-transplant cellular and pharmacological therapies, and judicious post-transplant monitoring are important strategies for reducing risk of relapse. Given its potential to cure, alloSCT will invariably remain a key part of the treatment algorithm. This article reviews the data underpinning the role and outcomes of alloSCT and provides an update on current recommendations.

Keywords:

• Chronic myeloid leukemia
• allogeneic stem cell transplant
• tyrosine kinase inhibitors
• chronic phase
• advanced phase
• blast phase
• TKI resistance

Disclosure statement

KT and JHL are entirely responsible for the content of this review. There are no conflicts to be declared. No funding for this review.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.