Stem cell transplantation in patients with chronic myelogenous leukemia: When should it be used?

Michael J. Mauro, Richard Maziarz

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Hematopoletic stem cell transplantation has been a cornerstone of therapy for chronic myelogenous leukemia (CML) for more than 15 years and is still a standard treatment option for patients with CML. The advent of imatinib mesylate, an inhibitor of the molecular defect driving CML, the BCR-ABL tyrosine kinase, has rewritten treatment algorithms for this disease and das shifted focus away from allografting. Despite advances in stem cell transplantation, such as broader availability with site use of modified conditioning regimens, use of allografting has diminished. Also, the nearly universal patient exposure to imatinib or other kinase inhibitors before transplantation may affect the biology of the disease that is currently being treated with an allograft and ultimately may affect outcomes. Exceedingly high rates of meaningful and stable response with longer folllow-up continue to drive enthusiasm for imatinib use, and understanding of resistance mechanisms has driven rapid investigation of second-generation tyrosine kinase inhibitors to address imatinib failure and suboptimal response. In most patients, imatinib reduces CML to a minimal residual disease state in which options to further deepen remission, such as immunotherapy, are sought; monitoring techniques and interpretation of response advance in parallel to meet demands; and uncertainty remains as a new natural history of CML is defined in an era of kinase inhibitor therapy. This review summarizes the state of transplant and nontransplant therapy for CML and discusses the decision making for patients with an aim to optimize the use of our test therapies for CML in an era of uncertainty.

Original languageEnglish (US)
Pages (from-to)404-416
Number of pages13
JournalMayo Clinic Proceedings
Volume81
Issue number3
DOIs
StatePublished - 2006

Fingerprint

Stem Cell Transplantation
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Homologous Transplantation
Protein-Tyrosine Kinases
Uncertainty
Phosphotransferases
Therapeutics
Residual Neoplasm
Immunotherapy
Allografts
Decision Making
Transplantation
Imatinib Mesylate
Transplants

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Stem cell transplantation in patients with chronic myelogenous leukemia : When should it be used? / Mauro, Michael J.; Maziarz, Richard.

In: Mayo Clinic Proceedings, Vol. 81, No. 3, 2006, p. 404-416.

Research output: Contribution to journalArticle

@article{0ae7e42712a44d12a12f6f575e8d7c36,
title = "Stem cell transplantation in patients with chronic myelogenous leukemia: When should it be used?",
abstract = "Hematopoletic stem cell transplantation has been a cornerstone of therapy for chronic myelogenous leukemia (CML) for more than 15 years and is still a standard treatment option for patients with CML. The advent of imatinib mesylate, an inhibitor of the molecular defect driving CML, the BCR-ABL tyrosine kinase, has rewritten treatment algorithms for this disease and das shifted focus away from allografting. Despite advances in stem cell transplantation, such as broader availability with site use of modified conditioning regimens, use of allografting has diminished. Also, the nearly universal patient exposure to imatinib or other kinase inhibitors before transplantation may affect the biology of the disease that is currently being treated with an allograft and ultimately may affect outcomes. Exceedingly high rates of meaningful and stable response with longer folllow-up continue to drive enthusiasm for imatinib use, and understanding of resistance mechanisms has driven rapid investigation of second-generation tyrosine kinase inhibitors to address imatinib failure and suboptimal response. In most patients, imatinib reduces CML to a minimal residual disease state in which options to further deepen remission, such as immunotherapy, are sought; monitoring techniques and interpretation of response advance in parallel to meet demands; and uncertainty remains as a new natural history of CML is defined in an era of kinase inhibitor therapy. This review summarizes the state of transplant and nontransplant therapy for CML and discusses the decision making for patients with an aim to optimize the use of our test therapies for CML in an era of uncertainty.",
author = "Mauro, {Michael J.} and Richard Maziarz",
year = "2006",
doi = "10.4065/81.3.404",
language = "English (US)",
volume = "81",
pages = "404--416",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "3",

}

TY - JOUR

T1 - Stem cell transplantation in patients with chronic myelogenous leukemia

T2 - When should it be used?

AU - Mauro, Michael J.

AU - Maziarz, Richard

PY - 2006

Y1 - 2006

N2 - Hematopoletic stem cell transplantation has been a cornerstone of therapy for chronic myelogenous leukemia (CML) for more than 15 years and is still a standard treatment option for patients with CML. The advent of imatinib mesylate, an inhibitor of the molecular defect driving CML, the BCR-ABL tyrosine kinase, has rewritten treatment algorithms for this disease and das shifted focus away from allografting. Despite advances in stem cell transplantation, such as broader availability with site use of modified conditioning regimens, use of allografting has diminished. Also, the nearly universal patient exposure to imatinib or other kinase inhibitors before transplantation may affect the biology of the disease that is currently being treated with an allograft and ultimately may affect outcomes. Exceedingly high rates of meaningful and stable response with longer folllow-up continue to drive enthusiasm for imatinib use, and understanding of resistance mechanisms has driven rapid investigation of second-generation tyrosine kinase inhibitors to address imatinib failure and suboptimal response. In most patients, imatinib reduces CML to a minimal residual disease state in which options to further deepen remission, such as immunotherapy, are sought; monitoring techniques and interpretation of response advance in parallel to meet demands; and uncertainty remains as a new natural history of CML is defined in an era of kinase inhibitor therapy. This review summarizes the state of transplant and nontransplant therapy for CML and discusses the decision making for patients with an aim to optimize the use of our test therapies for CML in an era of uncertainty.

AB - Hematopoletic stem cell transplantation has been a cornerstone of therapy for chronic myelogenous leukemia (CML) for more than 15 years and is still a standard treatment option for patients with CML. The advent of imatinib mesylate, an inhibitor of the molecular defect driving CML, the BCR-ABL tyrosine kinase, has rewritten treatment algorithms for this disease and das shifted focus away from allografting. Despite advances in stem cell transplantation, such as broader availability with site use of modified conditioning regimens, use of allografting has diminished. Also, the nearly universal patient exposure to imatinib or other kinase inhibitors before transplantation may affect the biology of the disease that is currently being treated with an allograft and ultimately may affect outcomes. Exceedingly high rates of meaningful and stable response with longer folllow-up continue to drive enthusiasm for imatinib use, and understanding of resistance mechanisms has driven rapid investigation of second-generation tyrosine kinase inhibitors to address imatinib failure and suboptimal response. In most patients, imatinib reduces CML to a minimal residual disease state in which options to further deepen remission, such as immunotherapy, are sought; monitoring techniques and interpretation of response advance in parallel to meet demands; and uncertainty remains as a new natural history of CML is defined in an era of kinase inhibitor therapy. This review summarizes the state of transplant and nontransplant therapy for CML and discusses the decision making for patients with an aim to optimize the use of our test therapies for CML in an era of uncertainty.

UR - http://www.scopus.com/inward/record.url?scp=33644665740&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644665740&partnerID=8YFLogxK

U2 - 10.4065/81.3.404

DO - 10.4065/81.3.404

M3 - Article

C2 - 16529146

AN - SCOPUS:33644665740

VL - 81

SP - 404

EP - 416

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 3

ER -