Allogeneic Stem Cell Transplantation for Chronic Myeloid Leukemia in the Era of Tyrosine Kinase Inhibitors- What are the Limitations?

The treatment strategies for chronic myeloid leukemia have changed dramatically with the advent of tyrosine kinase inhibitors. Since they provide an excellent opportunity for complete cytogenetic and molecular remissions, they are recommended as a first line therapy. Although a small fraction of patients has been reported to remain in molecular remissions after discontinuing of tyrosine kinase inhibitors, there is an increased likelihood of disease relapse after these drugs are discontinued. Therefore, allogeneic stem cell transplantation remains the only cure at present. However, toxicity of preparative regimens, development of graft versus host disease, infectious complications, and increased rates of relapse in advanced phases of the disease limit the safety and efficacy of this approach. This review highlights the major limitations of transplantation and the areas of studies required to improve the clinical outcomes.