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The Role of Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Myelogenous Leukemia Patients in the Era of Tyrosine Kinase Inhibitors

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Allogeneic Stem Cell Transplantation

Part of the book series: Contemporary Hematology ((CH))

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Abstract

When the history of hematopoietic stem cell transplantation (HSCT) for chronic myeloid leukemia (CML) is reviewed, it is observed that the improved outcomes were a consequence of slow and incremental change over the years, as a result of prospective clinical trials or retrospective institutional or registry observations and analyses. This gradual progress of therapeutic advancement was an excellent demonstration of Darwinian evolution. Gould et al. have developed a novel evolution theory of “punctuated equilibrium,” in which periods of incremental change can be disrupted by sudden and sometimes cataclysmic events [1]. In the management of CML, the relatively sudden introduction of tyrosine kinase inhibitors (TKIs) into the disease management has led to saltatory evolutionary changes in which major paradigm shifts have taken place in the treatment of CML patients. In this chapter, we will review the results of HSCT for CML and also review the impact on standard transplantation with the emergence of imatinib and other kinase inhibitors, and how they have now redefined a new natural history for this leukemia. More importantly, with the near universal exposure of patients with CML to TKIs, it will be most critical to define when transplantation options should be pursued and offered to maintain the therapeutic goal of the best long-term outcome for patients with this disease.

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  1. Center for Hematologic Malignancies, Adult Bone Marrow Transplantation Program, Oregon Health Science Cancer Institute, Oregon Health & Science University, Portland, OR, USA

    Richard T. Maziarz

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  1. University Hospitals Case Medical Center, Cleveland, OH, USA

    Hillard M. Lazarus

  2. Case Western Reserve University, Cleveland, OH, USA

    Mary J. Laughlin

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Maziarz, R.T. (2010). The Role of Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Myelogenous Leukemia Patients in the Era of Tyrosine Kinase Inhibitors. In: Lazarus, H.M., Laughlin, M.J. (eds) Allogeneic Stem Cell Transplantation. Contemporary Hematology. Humana Press. https://doi.org/10.1007/978-1-59745-478-0_5

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