title: The role of hematopoietic stem cell transplantation in chronic myeloid leukemia.
abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) is currently recommended as 2nd or 3rd line therapy for patients with chronic myeloid leukemia (CML) in first chronic phase or as salvage for patients with very advanced disease. As a consequence, numbers of HSCT in chronic phase have dropped significantly since the introduction of tyrosine kinase inhibitors (TKI), numbers of transplants in advanced disease to a lesser extent. These current recommendations consider primarily disease risk, defined as failure of TKI therapy; they might need to be adapted. We propose a more balanced appraisal of HSCT for individual patients which should include disease risk, transplant risk, and macroeconomic aspects. HSCT should be integrated into the treatment algorithms from diagnosis and be considered very early at first TKI failure for patients with high disease but low transplant risk. For patients with very advanced disease and high transplant risk in contrast, HSCT might only be recommended in a restricted research setting.
authors: Hematology, University Hospital, Dittingerstrasse 4, 4053, Basel, Switzerland, alois.gratwohl@unibas.ch.
authors: Alois
authors: A
authors: Gratwohl
authors: Helen
authors: H
authors: Baldomero
authors: Jakob
authors: J
authors: Passweg
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000009:adverse effects; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000201:enzymology / Q000503:physiopathology / Q000628:therapy*; D058990:Molecular Targeted Therapy / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D018570:Risk Assessment; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011505:Protein-Tyrosine Kinases