Stem cell transplantation for chronic myeloid leukemia (CML): current indications and perspectives

The introduction of tyrosine kinase inhibitors (TKIs) has reduced the indications for allogeneic stem cell transplants (SCT) in patients with chronic myeloid leukemia (CML) from 1500/year in 2000 to approximately 500/year in 2010. The recently updated indications by the European Leukemia Network include advanced-phase CML and nonresponders to second-line TKIs. Changes in transplant programs, over the past decade, have resulted in a significant reduction in transplant related mortality and this has expanded the transplant option to older patients, who may be eligible for SCT. Transplantation for blastic phase CML remains a challenge due to the high rate of post-transplant relapses. Thus, in view of this issue, several studies of TKIs after allogeneic SCT have been undertaken with encouraging results. In conclusion, allogeneic SCT remains a therapeutic option for selected patients with CML and is currently being integrated with the use of TKIs both before and after transplantation.