title: Challenges for allogeneic hematopoietic stem cell transplantation in chronic myeloid leukemia in the era of tyrosine kinase inhibitors.
abstract: Following the introduction of the tyrosine kinase inhibitor (TKI) imatinib in the treatment of chronic myeloid leukemia (CML) patients, the allogeneic hematopoietic stem cell transplantation (HSCT) scene in CML has changed dramatically. The number of patients receiving HSCT in first chronic phase (CP) has declined rapidly, as allogeneic HSCT in CP is now performed in these patients only in case of failure or intolerance of TKIs. Second, those CML patients who undergo allogeneic HSCT represent a selection of high-risk patients due to more advanced disease with high rates of accelerated or blast phase (being associated with an increased relapse risk), advanced age and relevant co-morbidities. Efforts at meeting these special challenges are being developed: treatment with TKIs aims to improve the pre-transplant remission status before HSCT. Dose-reduced conditioning protocols were introduced to decrease transplant-related mortality in patients with co-morbidities or older age. In the post-transplant period, TKIs may be administered for prophylaxis and for treatment of post-transplant relapse. Still, the outcome of patients in advanced CML phases remains guarded, and requires an improvement in current transplant strategies.
authors.affiliation: Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
authors.forename: Anthony
authors.initials: A
authors.lastname: Oyekunle
authors.forename: Evgeny
authors.initials: E
authors.lastname: Klyuchnikov
authors.forename: Sunday
authors.initials: S
authors.lastname: Ocheni
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Axel R
authors.initials: AR
authors.lastname: Zander
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000601:surgery*; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors