Therapeutic decision making in BMT/SCT for chronic myeloid leukemia and other myeloproliferative syndromes

Classification of chronic myeloid leukemia page 57 Staging of CML 58 Prognostic factors for outcome with conventional chemotherapy 58 Definitions of hematologic, cytogenetic, and molecular responses 59 Results with conventional therapy 60 Results with allogeneic transplant 61 CIBMTR-data 61 Donor lymphocyte infusions for relapse of CML after allogeneic transplant 64 Results with allogeneic transplant for CML in children 66 Results with autologous transplant for CML 66 Results with reduced-intensity allogeneic transplant for CML 66 Results with allogeneic transplant for myeloproliferative syndromes other than CML 67 Indications for allogeneic transplant in CML (Recommendations of the European Leukemia NET) 67 Contraindications 68 Pretransplant workup 68 Monitoring posttransplant 69 Further Reading 69 Classification of chronic myeloid leukemia Clinical variants of chronic myeloid leukemia (CML): Typical CML (Philadelphia chromosome present, bcr/abl-positive (94%) Atypical CML (Philadelphia chromosome absent, bcr/abl-positive (4%) Atypical bcr/abl negative CML (Philadelphia chromosome absent, bcr/abl-negative (2%) Staging of CML Chronic phase: No significant symptoms None of the features of accelerated phase or blastic phase Accelerated phase (any one or more of the following criteria): WBC count difficult to control with conventional use of imatinib or busulfan/hydroxyurea in terms of doses required Rapid doubling of WBC count (≤5 days) ≥10% blasts in blood or marrow ≥20% blasts plus promyelocytes in blood or marrow ≥20% basophils plus eosinophils in blood Anemia or thrombocytopenia unresponsive to imatinib Persistent thrombocytosis Additional chromosome changes (evolving new clone) Increasing splenomegaly Development of chloromas or myelofibrosis Patient in a second (or subsequent) chronic phase after blast crisi