Bone marrow transplantation for chronic myelogenous leukemia

Abstract

Allogeneic bone marrow transplantation represents the only therapeutic modality with proved curative potential in chronic myelogenous Ieukemia (CML). Associated morbidity and mortality still limits its use to young patients that are fortunate to have an HLA-compatible donor. Preliminary results currently documented in the literature are questioning the very first affirmative, since for low risk patients the results with interferon are superimposed to those of the transplant, during the first years of observation. Interferon is not free of complications, tolerance is limited in elderly patients and prolonged molecular remissions, as documented after transplantation, have not been reproduced with any other drug combination. Initial good results with the new tyrosine kinase inhibitors make the decision today even more complex with the greater availability of unrelated donors for BMT and positive results described worldwide. Donor Iymphocyte infusions as an effective strategy to rescue patients from early relapse have brought a whole new prospective to salvage patients who might now be considered for non-myeloablative regimens and new modalities of graft-versus host disease prophylaxis. The assessment of quality of life of patients treated with different modalities will be critical for the final decision regarding the ultimate approach of these patients.