Chronic myelogenous leukemia

The advent of tyrosine kinase inhibitor (TKI) therapy dramatically and irreversibly altered the treatment of chronic myeloid leukemia (CML). However, often forgotten is that prior to the TKI era, the most common use of allogeneic stem cell transplantation (BMT) was CML. This chapter discusses the current indications for BMT in the care of the CML patient. Reduced-intensity conditioning (RIC) regimens would seem particularly well suited for chronic phase CML, given the median age of diagnosis in CML is 67, and the well described sensitivity of CML to the graft-versus-leukemia (GvL) effect. Among patients with relapse, factors adversely affecting long-term survival include a short interval between transplant and relapse, prolonged time from diagnosis to transplant, having an unrelated donor, and advanced phase disease. Early detection of relapse is important, given the fact that response to TKIs or donor leukocyte infusion (DLI) work better with less disease burden, and in chronic phase.