Management of adult patients with CMML undergoing allo-HCT: recommendations from the EBMT PH&G Committee

• Published in: Blood Vol. 143; no. 22; pp. 2227 - 2244
• Main Authors: Onida, Francesco, Gagelmann, Nico, Chalandon, Yves, Kobbe, Guido, Robin, Marie, Symeonidis, Argiris, de Witte, Theo, Itzykson, Raphael, Jentzsch, Madlen, Platzbecker, Uwe, Santini, Valeria, Sanz, Guillermo, Scheid, Christof, Solary, Eric, Valent, Peter, Greco, Raffaela, Sanchez-Ortega, Isabel, Yakoub-Agha, Ibrahim, Pleyer, Lisa
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 30.05.2024; American Society of Hematology
• Series: Blood
• Subjects: Life Sciences
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood.2023023476

[Display omitted] Chronic myelomonocytic leukemia (CMML) is a heterogeneous disease presenting with either myeloproliferative or myelodysplastic features. Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only potentially curative option, but the inherent toxicity of this procedure makes the decision to proceed to allo-HCT challenging, particularly because patients with CMML are mostly older and comorbid. Therefore, the decision between a nonintensive treatment approach and allo-HCT represents a delicate balance, especially because prospective randomized studies are lacking and retrospective data in the literature are conflicting. International consensus on the selection of patients and the ideal timing of allo-HCT, specifically in CMML, could not be reached in international recommendations published 6 years ago. Since then, new, CMML-specific data have been published. The European Society for Blood and Marrow Transplantation (EBMT) Practice Harmonization and Guidelines (PH&G) Committee assembled a panel of experts in the field to provide the first best practice recommendations on the role of allo-HCT specifically in CMML. Recommendations were based on the results of an international survey, a comprehensive review of the literature, and expert opinions on the subject, after structured discussion and circulation of recommendations. Algorithms for patient selection, timing of allo-HCT during the course of the disease, pretransplant strategies, allo-HCT modality, as well as posttransplant management for patients with CMML were outlined. The keynote message is, that once a patient has been identified as a transplant candidate, upfront transplantation without prior disease-modifying treatment is preferred to maximize chances of reaching allo-HCT whenever possible, irrespective of bone marrow blast counts. Chronic myelomonocytic leukemia (CMML) is a rare disease with poor prognosis, for which the only potentially curative treatment is allogeneic hematopoietic stem cell transplant (allo-HCT). The evidence base for deciding who, when, and how to perform allo-HCT is growing but remains underdeveloped. In this Special Report, an international panel of experts reviews current knowledge and provides recommendations for patient selection and transplant-regimen choices.