When is allogeneic stem cell transplant recommended for chronic myeloid leukaemia?

Most treatment planning for chronic myeloid leukaemia begins with targeted medicines that block the abnormal signal driving leukaemia cells. A donor transplant replaces the blood-forming system after conditioning treatment and creates a new immune response against the disease. It is usually discussed when the leukaemia does not respond adequately, develops resistance to available targeted medicines, causes serious treatment intolerance, or enters an advanced phase. The team considers molecular response, disease phase, previous medicines, donor compatibility, age, organ function, and infection risk.

Do not stop a targeted medicine on your own. Ask for a review of molecular test results, adherence, drug interactions, and alternative targeted options before a transplant decision. If transplant is being considered, evaluation may include donor typing, blood tests, heart and lung checks, infection screening, dental care, and fertility counselling. Plan for a caregiver and frequent follow-up during recovery.

Call the haematology service urgently for fever, new breathlessness, chest pain, severe weakness, unusual bleeding, sudden confusion, or rapidly increasing abdominal fullness. During transplant recovery, report fever, rash, persistent diarrhoea, yellow skin, mouth sores that prevent drinking, or reduced urine without delay. These symptoms can reflect infection, blood-count changes, graft-versus-host disease, or organ stress.

Ask whether my molecular response shows resistance, which targeted medicines remain possible, why transplant is being considered now, whether a donor search should start, and how the risks compare with continuing or changing medicine.