Does chronic myeloid leukemia require allogeneic hematopoietic stem cell transplantation?
Chronic Myeloid Leukemia (CML) is a type of blood cancer that is often diagnosed during its chronic phase. Most patients can expect a long-term survival with the help of targeted chemotherapy, and this often makes Hematopoietic Stem Cell Transplantation (HSCT) unnecessary for them. However, there are certain circumstances where HSCT may be considered. This includes when all targeted chemotherapy treatments have failed, when a patient is initially diagnosed during the acute phase of the disease, or when the disease has progressed into the acute phase. It's important to know that the risks associated with transplantation are taken into account in these situations.
For patients who have transitioned into the acute phase of CML, the first step is to undergo treatment aimed at returning the disease to its chronic phase. This is done prior to proceeding with allogeneic stem cell transplantation. However, because the duration of the chronic phase can be short and the prognosis associated with it can be poor, it is generally recommended to move forward with the allogeneic stem cell transplantation as promptly as possible once the disease has returned to the chronic phase.
How does the allogeneic hematopoietic stem cell transplantation proceed?
When considering Hematopoietic Stem Cell Transplantation (HSCT), it's crucial to test whether the Major Histocompatibility Antigen (HLA) matches. The closer the match, the better the chances of a successful transplant. However, even if it does not match, a transplant can still be performed using a mismatched unrelated donor or haploidentical familial donor.
For individuals diagnosed in the acute phase of Chronic Myeloid Leukemia (CML), or for those whose disease has progressed to the acute phase, treatment typically begins with a combination of cytotoxic chemotherapy and targeted therapy. The goal of this treatment is to revert the disease back to its chronic phase. Once this has been achieved, the timing of the transplantation can be assessed.
