Role of stem cell transplant in chronic myeloid leukemia in contemporary settings

The discovery of “magic bullet oral tyrosine kinase inhibitors (TKIs)” has revolutionized the treatment landscape for chronic myeloid leukemia (CML) and supplanted the use of allogeneic hematopoietic stem cell transplant (SCT) as a first-line treatment. Similar trends were observed in India also. Despite the remarkable improvement in outcomes of chronic phase CML, therapeutic challenges persist demanding alternative therapy for patients encountering tyrosin kinase resistance or intolerance. Allogeneic hematopoietic stem cell transplant (HSCT) retains its significance, especially in refractory and intolerant cases, with careful consideration of the patient’s specific factors and disease phases. The optimal timing of allogeneic SCT remains crucial as the disease phase exerts a substantial impact on outcomes. Allogeneic HSCT is cost cost-effective, viable, and potential curative option for managing T315I mutant CML in resource-constrained countries like India. Allogeneic HSCT is an essential therapeutic option, offering long-term remission and disease control compared to TKI alone in an advanced phase of CML. Moreover, pre-transplant TKI therapy exhibits safety and improves post-transplant survival outcomes, while post-transplant TKI maintenance therapy decreases relapsed rate. It is advisable to conduct regular monitoring using sensitive techniques for an indefinite period following transplantation. These insights stress the imperative of tailored therapeutic strategies and vigilant monitoring to optimize outcomes for CML patients in contemporary clinical settings.