Chronic myelomonocytic leukemia (CMML) is a heterogeneous disease presenting with either myeloproliferative or myelodysplastic features. Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only potentially curative option, but the inherent toxicity of this procedure makes the decision to proceed to allo-HCT challenging, particularly as patients with CMML are mostly older and comorbid. Therefore, the decision between a non-intensive treatment approach and allo-HCT represents a delicate balance, especially since prospective randomized studies are lacking and retrospective data in the literature is conflicting. International consensus on the selection of patients and the ideal timing of allo-HCT specifically in CMML could not be reached in international recommendations published six years ago. Since then, new, CMML-specific data have been published. The European Society for Blood and Marrow Transplantation (EBMT) Practice Harmonization and Guidelines Committee assembled a panel of experts in the field to provide the first best practice recommendations on the role of allo-HCT specifically in CMML. Recommendations were based on the results of an international survey, a comprehensive review of the literature, and expert opinions on the subject, after structured discussion and circulation of recommendations. Algorithms for patient selection, timing of allo-HCT during the course of the disease, pre-transplant strategies, allo-HCT modality, as well as post-transplant management for patients with CMML were outlined.
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Review Article|
March 17, 2024
Management of adult patients with CMML undergoing allo-HCT: recommendations from the EBMT PH&G Committee
Francesco Onida,
Francesco Onida
Hematology and BMT Unit, ASST Fatebenefratelli-Sacco, Dept. of Oncology and Hemato-Oncology, University of Milan, Italy, Milan, Italy
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Nico Gagelmann,
Nico Gagelmann
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Yves Chalandon,
Yves Chalandon
University Hospital of Geneva, Geneva, Switzerland
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Guido Kobbe,
Guido Kobbe
Heinrich Heine University, Medical Faculty, Duesseldorf, Germany
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Marie Robin,
Marie Robin
Hopital Saint Louis, Paris, France
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Argiris Symeonidis,
Argiris Symeonidis
Olympion General Hospital & Rehabilitation Center, Department of Hematology, Greece
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Theo M. de Witte,
Theo M. de Witte
Radboud University Medical Centre, Nijmegen, Netherlands
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Raphaël A. Itzykson,
Raphaël A. Itzykson
Hopital Saint-Louis, Paris, France
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Madlen Jentzsch,
Madlen Jentzsch
University of Leipzig, Leipzig, Germany
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Uwe Platzbecker,
Uwe Platzbecker
University Hospital Leipzig, Department of Hematology and Cell Therapy, Leipzig, Germany
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Valeria Santini,
Valeria Santini
MDS Unit, Hematology, AOU Careggi-University of Florence, Florence, Italy
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Guillermo F. Sanz,
Guillermo F. Sanz
Hospital Universitario y Politécnico La Fe, Valencia, Spain, Health Research Institute La Fe, Valencia, Spain, and CIBERONC, Instituto de Salud Carlos III, Madrid, Spain, Valencia, Spain
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Christoph Scheid,
Christoph Scheid
University of Cologne, Cologne, Germany
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Peter Valent,
Peter Valent
Medical University of Vienna, Vienna, Austria
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Raffaela Greco,
Raffaela Greco
EBMT Practice Harmonization and Guidelines Committee., Spain
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Isabel Sánchez-Ortega,
Isabel Sánchez-Ortega
EBMT, Executive Office, Barcelona, Spain
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Ibrahim Yakoub-Agha,
Ibrahim Yakoub-Agha
EBMT Practice Harmonization and Guidelines Committee., Spain
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Lisa Pleyer
Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria and Cancer Cluster Salzburg (CCS), Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria, Austria
* Corresponding Author; email: dr.lisa.pleyer@gmail.com
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Blood blood.2023023476.
Article history
Submitted:
December 6, 2023
Revision Received:
February 7, 2024
Accepted:
February 23, 2024
Citation
Francesco Onida, Nico Gagelmann, Yves Chalandon, Guido Kobbe, Marie Robin, Argiris Symeonidis, Theo M. de Witte, Raphaël A. Itzykson, Madlen Jentzsch, Uwe Platzbecker, Valeria Santini, Guillermo F. Sanz, Christoph Scheid, Eric Solary, Peter Valent, Raffaela Greco, Isabel Sánchez-Ortega, Ibrahim Yakoub-Agha, Lisa Pleyer; Management of adult patients with CMML undergoing allo-HCT: recommendations from the EBMT PH&G Committee. Blood 2024; blood.2023023476. doi: https://doi.org/10.1182/blood.2023023476
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