Advantages and disadvantages of two up-front therapeutic approaches to chronic myeloid leukemia (CML).
| Approach . | Advantages . | Disadvantages . |
|---|---|---|
| Abbreviations: Allo-SCT, allogeneic stem cell transplantation; RICT, reduced intensity conditioning transplantation; DLI, donor lymphocyte infusion | ||
| Allo-SCT for selected patients | Proven curative ability | Transplant-related mortality |
| Decreased risk of progression of disease | Transplant-related morbidity | |
| Ability to integrate imatinib, RICT and DLI | Chronic graft-versus-host disease | |
| Psychological (some patients) | Late effects (e.g., secondary malignancy, endocrine imbalance, cataract formation) | |
| Trial of imatinib for all patients | Avoids transplant-related mortality and morbidity for some | No long-term survival data |
| Curative ability unknown | ||
| Psychological (some patients) | Emerging resistance | |
| Delaying curative therapy | ||
| Risk of progression | ||
| Allo-SCT more likely to be performed for advanced phase disease | ||
| Approach . | Advantages . | Disadvantages . |
|---|---|---|
| Abbreviations: Allo-SCT, allogeneic stem cell transplantation; RICT, reduced intensity conditioning transplantation; DLI, donor lymphocyte infusion | ||
| Allo-SCT for selected patients | Proven curative ability | Transplant-related mortality |
| Decreased risk of progression of disease | Transplant-related morbidity | |
| Ability to integrate imatinib, RICT and DLI | Chronic graft-versus-host disease | |
| Psychological (some patients) | Late effects (e.g., secondary malignancy, endocrine imbalance, cataract formation) | |
| Trial of imatinib for all patients | Avoids transplant-related mortality and morbidity for some | No long-term survival data |
| Curative ability unknown | ||
| Psychological (some patients) | Emerging resistance | |
| Delaying curative therapy | ||
| Risk of progression | ||
| Allo-SCT more likely to be performed for advanced phase disease | ||