Following the introduction of tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML), allogeneic stem cell transplantation (SCT) took a shift towards high-risk patients. Considering the high relapse rates post-transplant in these selected patients, several studies evaluated post-transplant use of the tyrosine kinase inhibitor (TKI) imatinib. Although the number of studies are still limited, and data have to be confirmed by additional studies, safety of imatinib even within the first months after SCT seems to be acceptable. Imatinib was shown to be effective in patients with molecular or hematological relapse of chronic or accelerated phase post-transplant, while outcomes in blast phase were more unfavorable. The compound further seemed beneficial for prophylactic use in patients who achieved complete remission post-transplant. The combination of imatinib with donor lymphocytes did not result in increased toxicity or graft versus host disease. First studies suggest that second generation TKIs such as dasatinib or nilotinib are manageable post-transplant with acceptable toxicity as well. In conclusion, TKIs of the first and second generation are promising options for the post-transplant period of patients with CML, but algorithms for dosage, intervals from SCT, duration of application, and the combination with donor lymphocytes still have to be developed.
Following the introduction of tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML), allogeneic stem cell transplantation (SCT) took a shift towards high-risk patients. Considering the high relapse rates post-transplant in these selected patients, several studies evaluated post-transplant use of the tyrosine kinase inhibitor (TKI) imatinib. Although the number of studies are still limited, and data have to be confirmed by additional studies, safety of imatinib even within the first months after SCT seems to be acceptable. Imatinib was shown to be effective in patients with molecular or hematological relapse of chronic or accelerated phase post-transplant, while outcomes in blast phase were more unfavorable. The compound further seemed beneficial for prophylactic use in patients who achieved complete remission post-transplant. The combination of imatinib with donor lymphocytes did not result in increased toxicity or graft versus host disease. First studies suggest that second generation TKIs such as dasatinib or nilotinib are manageable post-transplant with acceptable toxicity as well. In conclusion, TKIs of the first and second generation are promising options for the post-transplant period of patients with CML, but algorithms for dosage, intervals from SCT, duration of application, and the combination with donor lymphocytes still have to be developed.