Who with chronic myelogenous leukemia to transplant in the era of tyrosine kinase inhibitors?

PURPOSE OF REVIEW: Chronic myelogenous leukemia was once the most common indication for unrelated allogeneic hematopoietic stem cell transplantation but has become dramatically less so during the past 5 years. This procedure remains an option in chronic myelogenous leukemia but its use will become more sparing and selective. This review describes these trends and identifies the current role of the procedure in chronic myelogenous leukemia. RECENT FINDINGS: Allogeneic hematopoietic stem cell transplantation was the goal in chronic myelogenous leukemia for over 20 years and remains an option. Emergence of imatinib mesylate and other, second-generation tyrosine kinase inhibitors has transformed the landscape of transplantation in this setting. Treatment algorithms have been rewritten and, despite advances in hematopoietic stem cell transplantation (e.g. improved supportive care, decreased toxicity and reduced intensity conditioning), transplantation worldwide has declined. Additionally, the near universal exposure to imatinib mesylate or other kinase inhibitors before transplant consideration has increased expectations regarding outcomes after transplantation. SUMMARY: This review summarizes the history of transplantation for chronic myelogenous leukemia and defines the new natural history for this leukemia in the tyrosine kinase inhibitor era. Ultimately, enhanced understanding of the appropriate role of transplantation in these patients will lead to the best long-term outcomes.