Treatment of advanced phase CML

• Accelerated phase patients on imatinib 600mg od have haematological and cytogenetic responses, prolongation of time to progression and improved survival. Eligible patients should receive an allograft.

• Blast crisis CML responds to imatinib 600mg od in a high proportion of cases with less toxicity than chemotherapy but response duration is short and where possible an allograft should be performed.

• Allogeneic BMT offers eligible patients with advanced phase CML the only prospect of prolonged survival and possible cure; results are significantly less good than for BMT in chronic phase (0-10% 5 year survival in blast crisis) though achievement of second chronic phase improves the results after blast crisis.

• Relapse after allogeneic BMT has been successfully treated with donor lymphocyte infusions (DLI) (60-80% response in molecular or cytogenetic relapse); GvHD is a side effect but is less frequent with incremental doses of DLI.

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