Table 5.

Recommendations for Role and Timing of Allogeneic HSCT in CML

Status	TKIs	Allogeneic HSCT
AP, BP	Interim treatment to MRD	If in remission
Imatinib or first-line second-generation TKI failure in CP, with T315I mutation	Ponatinib	If not responding well to ponatinib
Imatinib or first-line second-generation TKI failure in CP, no clonal evolution, no mutations, good initial response to imatinib	Long-term treatment with TKI in second-line setting	Third-line, post–second TKI failure
Imatinib or first-line second-generation TKI failure in CP, with clonal evolution, with mutations resistant to second-generation TKIs, no CyR to imatinib	Interim treatment with ponatinib eventually to MRD	As soon as possible if no response to ponatinib
Elderly patients, age >70 y, post–imatinib failure	Long-term treatment with TKI in second-line setting	Forego allogeneic HSCT for many years (maximize quality of life)

Abbreviations: AP = accelerated phase; BP = blast phase; CML = chronic myeloid leukemia; CP = chronic phase; CyR = cytogenetic response; HSCT = hematopoietic stem cell transplantation; MRD = minimal residual disease; TKI = tyrosine kinase inhibitor.