chapter  16
10 Pages

The decision whether to allograft a patient with CML John M Goldman

The decision whether to proceed to an allogeneic stem cell transplant (SCT) for a given patient with CML and the timing of the transplant have become very much more complex since allogeneic SCT was introduced into clinical practice in the early 1980s. This complexity reflects the fact that whereas survival without SCT has improved to a certain degree in the last 20 years, the results of SCT have also improved during this time. Moreover the development of the new tyrosine kinase inhibitor STI571 (Glivec) offers the prospect of further still unquantifiable improvement in non-transplant therapy. Thus it is difficult to provide for a new patient with CML an accurate estimate of the probability of survival with or without a transplant. To this uncertainty must be added the fact that some patients have strong views as to whether they do or do not wish to submit themselves to a transplant procedure regardless of the recommendation they may receive from their haematologist. In this chapter, I briefly review the factors influencing the probability of survival with conventional therapy or after allogeneic SCT, and discuss the possible poli-

cies that the clinician may adopt in advising an individual patient with newly diagnosed CML. I also discuss the place of allogeneic SCT for a patient with advanced-phase CML.