Role Of Allogeneic Transplantation

Since the first demonstration of its curative potential, allogeneic stem cell transplantation has played an important role in the management of CML. The results for a wide range of these clinical studies are reviewed in Chapter 37. The ability of both interferon and ima-tinib to affect the natural history of the disease has altered the initial treatment paradigms, and some debate has surrounded both the institution and the timing of stem cell transplantation in the course of therapy. Such treatment decisions are tempered by consideration of the risk/benefit ratio particularly, as it pertains to specific groups of patients.

Despite the current controversy surrounding the most appropriate time to proceed with allogeneic stem cell transplantation in CML, the experience with this modality has proven valuable as proof of concept regarding the clinical efficacy of immunotherapy. The model of the "graft-versus-leukemia" (GvL) effect has been further refined and, in turn, has given rise to immunology-based therapeutic strategies, such as donor leukocyte infusions (DLI) and reduced intensity, nonmyeloblative transplantation ("mini-transplants"). Such approaches have been pioneered in CML and applied, with varying degrees of success, in other forms of human leukemia.

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