was 78% in 131 patients treated for chronic-phase CML.32 Thus, the prognostic scoring systems of the past may not apply to the modern HSCT techniques available today.

The prognostic information available to the newly diagnosed patient with CML is both a blessing and a curse. While the patient may take comfort in knowing that cure is possible (and likely) with allogeneic HSCT, the relative safety, but lack of long-term prognostic information, of imatinib clouds decision making with regard to optimal treatment approaches. Clearly, patients with accelerated- or blast-phase CML should proceed as soon as possible to HSCT. For patients in chronic-phase CML, the issues are more controversial.

To sort through these issues, an expert panel was convened to provide treatment recommendations. They recommend that all patients be initiated on treatment with imatinib at diagnosis.33 "Selected" patients may be considered for HSCT prior to a full therapeutic trial of imatinib. Although the panel does not elaborate on the definition of "selected," one could imagine that a young patient with high-risk features, such as anemia, splenomegaly, and thrombocy-tosis, would be a good candidate for an initial transplant approach. Failure to achieve CCR on imatinib, or failure to tolerate imatinib, is also an indication for HSCT.33 The National Comprehensive Cancer Network (NCCN) has offered similar and more comprehensive guidelines.34

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