chapter  19
20 Pages

HLA-identical sibling transplantation David G Savage

Allogeneic stem cell transplantation (alloSCT) is the only curative therapy for chronic myeloid leukemia (CML) (Figure 18.1).1-5 As discussed elsewhere in this volume, there are several therapeutic alternatives for patients who are not ideal candidates for allografting. Chemotherapy with busulfan or hydroxyurea results in median survivals of about 4 years, but hydroxyurea is less toxic and easier to administer. Interferon- (IFN-) provides a survival advantage relative to hydroxyurea, but complete cytogenetic responders (only 10-20% of all those treated) remain positive for leukemia-specific (BCR/ABL) transcripts using the reverse-transcriptase polymerase chain reaction (RT-PCR) and do eventually relapse. Preliminary studies have shown that the novel tyrosine kinase inhibitor STI571 (Glivec) has remarkable activity in the treatment of CML, but its therapeutic role remains to be defined (see Chapter 34). Highdose therapy with autologous stem cell rescue may prolong survival but does not cure patients.5