Current role of stem cell transplantation in chronic myeloid leukaemia

Haematopoietic stem cell transplantation (HSCT) has seen considerable ups and downs in its role for patients with chronic myeloid leukaemia (CML). It has provided the first proof of the principle for cure and has confirmed the concept of successful immunotherapy of leukaemia. CML became the most frequent indication for an allogeneic HSCT worldwide. The frequency of HSCT declined rapidly when the specific BCR/ABL tyrosine kinase inhibitor (TKI) imatinib appeared. Today, a balanced view prevails. Risk assessment of both, disease risk and transplant risk, has become standard. Allogeneic HSCT remains the first-line approach for patients with CML in accelerated phase or blast crisis. It is the standard of care for patients with failed first-line therapy and a low-risk HSCT. It is the best option for all patients with failed second-line TKIs, with mutations T315I or with progressive disease. It can always be considered in situations with limited resources.