Chronic Leukemia Allogeneic hematopoietic cell transplantation is the only therapy shown to cure a substantial portion of patients with chronic myeloid leukemia (CML). Fiveyear disease-free survival rates are 15–20% for patients transplanted for blast crisis, 25–50% for accelerated-phase patients, and 60–70% for chronic phase patients, with cure rates as high as 80% at selected centers. Use of unrelated donors results in more GVHD and slightly worse survival than seen with matched siblings, although 3-year disease-free survival rates of 70% have been reported at some large centers. The timing of transplantation in CML has become more complicated with the introduction. | Chapter 108. Hematopoietic Cell Transplantation Part 9 Chronic Leukemia Allogeneic hematopoietic cell transplantation is the only therapy shown to cure a substantial portion of patients with chronic myeloid leukemia CML . Five-year disease-free survival rates are 15-20 for patients transplanted for blast crisis 25-50 for accelerated-phase patients and 60-70 for chronic phase patients with cure rates as high as 80 at selected centers. Use of unrelated donors results in more GVHD and slightly worse survival than seen with matched siblings although 3-year disease-free survival rates of 70 have been reported at some large centers. The timing of transplantation in CML has become more complicated with the introduction of imatinib mesylate a remarkably effective relatively nontoxic oral agent. Even though imatinib is not generally regarded as curative given its favorable toxicity profile most physicians favor its use as initial therapy for CML with transplantation being reserved for those who fail to achieve a complete cytogenetic response with imatinib relapse after an initial response or are intolerant of the drug Chap. 104 . Allogeneic transplantation has been used to only a limited extent for chronic lymphocytic leukemia in large part because of the chronic nature of the disease and because of the age profile of patients. With allogeneic transplantation complete remissions have been achieved in the majority of patients so far reported with disease-free survival rates of 50 at 3 years. However treatment-related mortality has been substantial and further follow-up is needed. Encouraging results have been seen using reduced intensity preparative regimens before allogeneic transplantation. Myelodysplasia Between 40 and 50 of patients with myelodysplasia appear to be cured with allogeneic transplantation. Results are better among younger patients and those with less-advanced disease. However some patients with myelodysplasia can live for extended periods without .
