Nonmyeloablative allogeneic stem cell transplantation for chronic myelogenous leukemia in the imatinib era.
Allogeneic stem cell transplantation (ASCT) is a potentially curative treatment for patients with chronic myelogenous leukemia (CML) and was previously considered the preferred treatment for newly diagnosed CML. The success of imatinib has changed treatment recommendations, and allogeneic transplants are now reserved for imatinib treatment failures. Previous imatinib treatment does not compromise the results of ASCT, but patients with overt transformed disease have poor results. It is unclear whether patients whose disease is considered to have failed imatinib should be referred immediately for ASCT or receive treatment with a second-generation tyrosine kinase inhibitors (TKI). Patients whose disease fails 2 TKIs should receive ASCT if possible. Nonmyeloablative preparative regimens reduce the toxicity and treatment-related mortality associated with the transplantation procedure and allow transplantations to be performed in older and medically infirm patients. This approach, including posttransplantation treatment with TKIs and donor lymphocyte infusion, produces a high fraction of durable molecular complete remissions.
Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. rchampli@mdanderson.org
Richard
R
Champlin
Marcos
M
de Lima
Partow
P
Kebriaei
Gabriela
G
Rondon
Tobi
T
Fisher
Elias
E
Jabbour
Jorge E
JE
Cortés
Hagop
H
Kantarjian
Paolo
P
Anderlini
Amin
A
Alousi
Chitra
C
Hosing
Elizabeth
E
Shpall
Uday
U
Popat
Muzaffar
M
Qazilbash
Borje
B
Andersson
Sergio
S
Giralt
D000328:Adult; D000368:Aged; D001549:Benzamides; D002471:Cell Transformation, Neoplastic; D020544:Graft vs Leukemia Effect; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D011743:Pyrimidines / Q000627:therapeutic use*; D012074:Remission Induction; D033581:Stem Cell Transplantation / Q000379:methods*; D013997:Time Factors; D014184:Transplantation, Homologous / Q000379:methods*; D016896:Treatment Outcome
D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases