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Background/Aim. Introducing tyrosine kinase inhibitors (TKIs) has essentially  changed curative approach, to be precise, clearly improved treatment  efficacy for chronic myeloid leukemia (CML). Thus, the place and usage of  allogeneic stem cell transplant (SCT) in CML treatment - as a former "nearly  monopolistic" therapeutic manner - is nowadays controversial. The objective  of this retrospective study was to evaluate the results obtained in the  treatment of CML patients, with a particular attempt to define parameters  critical for clinical benefit and superior overall outcome following  allogeneic SCT. Methods. A total of 32 CML patients (27 in chronic phase and  5 with advanced disease), with female/male ratio 11/21, aged from 9 to 54  (32 in average) years, underwent allogeneic SCTs (1993 to 2009). The initial  treatment for 25 patients was interferon alpha (IFN-α) with or without  ARA-C, and additional 7 patients with no response to imatinib mesylat (IM).  The time from diagnosis to SCT was approximately 12 (range 3- 37) months.  The patient were categorized according to the risk for the disease,  transplant-related mortality (TRM) scoring system, and stem cell (SC)  source. The basic conditioning regimen was a combination of busulphan and  cyclophosphamide (BuCy-2). Graft-versus-host disease (GvHD) was typically  prevented with cyclosporine-A (CsA) and methotrexate (MTX). Results.  Engraftment was observed in 26 (84.4%) patients, with polymorphonuclear  (PMNs) and platelet (Plt) recovery on the 15th (range 10-22) and 19th (range  11-29) posttranspalnt days, respectively. Acute GvHD (aGvHD) had 13/26  (50%), and chronic GvHD (cGvHD) 10/21 (47.1%) patients. The incidence of  overall TRM was 46.8% (15/32), while early death was noticed in 4 (12.5%)  patients. A cause of death in 9 (28.1%) patients was cGvHD, in 2 (6.25%)  patients infection, and in 3 (9.35%) cases disease-relapse was occurred.  Fourteen (43.7%) of the patients are still alive, 9 from the low-risk group  for TRM, with long-term survival from 1 to 16 years. Patients who received  SCs from peripheral blood (PB) vs bone marrow (BM) had significantly faster  engraftment (p < 0.05), lower oropharingeal mucositis rate (25% vs 70%; p <  0.05), but more frequent cGvHD (83.3% vs 30.3%; p < 0.05). A significantly  improved (log-rank = 2.39; p < 0.01) overall survival (OS) was obtained in  BM-setting. Conclusion. The results obtained in this study are in accordance  with data from analogous clinical trials. Exactly, in the era of the new  target therapy (TKI application), allogeneic SCT can be still a convenient  therapeutic approach for well-selected CMLpatients, especially for those  with initial high-risk disease and lower probability of TRM

Allogeneic stem cell transplant for chronic myeloid leukemia as a still promising option in the era of the new target therapy