Tyrosine kinase inhibitors and allogeneic hematopoietic cell transplantation for chronic myeloid leukemia: targeting both therapeutic modalities.

BACKGROUND Due to its curative potential, allogenic hematopoietic transplantation (HCT) was a mainstay of treatment for chronic myeloid leukemia (CML), but the advent of tyrosine kinase inhibitors (TKIs) has markedly altered the use of allogeneic HCT. METHODS The authors reviewed their experiences as well as the published data regarding the impact of TKIs on the natural history of CML and thus on the application and timing of TKIs in the management of CML. RESULTS Most patients with CML respond well to TKIs given as up-front therapy. Available retrospective data suggest that allogenic HCT is safe after TKI therapy. Work is ongoing regarding salvage of postallogeneic HCT failures using TKIs with and without donor lymphocyte infusion. CONCLUSIONS While allogeneic HCT therapy remains useful, the timing of its application in CML has changed, and it is now considered as second- or third-line therapy.