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Hematopoietic cell transplantation in chronic myeloid leukemia

Author
Robert S Negrin, MD
Section Editor
Nelson J Chao, MD
Deputy Editor
Alan G Rosmarin, MD

INTRODUCTION

Chronic myeloid leukemia (CML) is a myeloproliferative disorder associated with the Philadelphia chromosome t(9;22)(q34;q11) resulting in the BCR-ABL fusion gene. This genetic abnormality results in the formation of a unique gene product (BCR-ABL), which is a constitutively active tyrosine kinase. It is this deregulated tyrosine kinase that is implicated in the development of CML. (See "Molecular genetics of chronic myeloid leukemia".)

Inhibitors of this tyrosine kinase, most notably imatinib, dasatinib, and nilotinib, have been developed and used successfully to treat CML. Even with therapy, CML can progress from a relatively indolent disease (chronic stable phase) to a more aggressive disorder (accelerated phase), during which time disease control is more difficult to achieve. It can then culminate in an acute leukemia, termed "blast crisis," which is generally refractory to treatment. (See "Clinical manifestations and diagnosis of chronic myeloid leukemia".)

Treatment of CML with allogeneic hematopoietic cell transplantation (HCT) will be discussed here. Autologous HCT has been explored in a limited number of patients with CML. However, due to better alternatives, this treatment approach is rarely utilized. Other treatments options for CML are presented separately. (See "Overview of the treatment of chronic myeloid leukemia" and "Initial treatment of chronic myeloid leukemia in chronic phase" and "Treatment of chronic myeloid leukemia in accelerated phase" and "Treatment of chronic myeloid leukemia in blast crisis".)

The term "hematopoietic cell transplantation" (HCT) will be used throughout this review as a general term to cover transplantation of progenitor cells from any source (eg, bone marrow, peripheral blood, umbilical cord blood). Otherwise, the source of such cells will be specified (eg, peripheral blood progenitor cell transplantation). (See "Sources of hematopoietic stem cells".)

PRETRANSPLANT CONSIDERATIONS

Eligibility — Eligibility for allogeneic HCT varies across countries and institutions. Ultimately, decisions regarding transplant eligibility should be made on a case-by-case basis based on a risk-benefit assessment and the needs and wishes of the patient. General eligibility criteria are discussed in more detail separately. (See "Determining eligibility for allogeneic hematopoietic cell transplantation".)

                             

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Literature review current through: Nov 2016. | This topic last updated: Tue Apr 05 00:00:00 GMT+00:00 2016.
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