Post allogeneic transplantation maintenance for CML – pro
The issue here is adjuvant treatment with Tasigna after a successful stem cell transplantation. Relapse is a devastating event for patients with hematologic cancers treated with hematopoietic stem cell transplantation. In most situations, relapse treatment options are limited. Maintenance therapy offers the possibility of delaying or avoiding disease recurrence, but its role remains unclear in CML post transplant. However, the role of maintenance is not proven and it is still being investigated. In the myeloid malignancies MRD monitoring is already the standard of care in both chronic myeloid leukemia (CML). It can predict relapse, in which case treatment with TKIs is certainly established. However, routine maintenance is not established. One has to remember that graft versus leukemia effect is already a maintenance teatment that prevents relapses. A recent review (Barret and ito) conclides: “Although the use of posttransplant TKI therapy is widespread, prospective studies are needed to explore the best TKI dose, treatment duration, and coadministration with DLIs.”.
Christopher S. Hourigan et al, Back to the future! The Evolving Role of Maintenance Therapy after Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant. 2014 Feb; 20(2): 154–163.
Nishimoto M1, Nakamae H, Koh KR, Kosaka S, Matsumoto K, Morita K, Koh H, Nakane T, Ohsawa M, Hino M.
Dasatinib maintenance therapy after allogeneic hematopoietic stem cell transplantation for an isolated central nervous system blast crisis in chronic myelogenous leukemia. Acta Haematol. 2013;130(2):111-4.
A. John Barrett and Sawa Ito, The role of stem cell transplantation for chronic myelogenous leukemia in the 21st century. May 21, 2015; Blood: 125 (21)