Treatment versus Transplant for Challenging Hematologic Disorders

For many malignant and nonmalignant hematologic conditions, the only effective therapy is allogeneic hematopoietic cell transplantation (HCT). In these settings, the consulting transplant physician often has the luxury of focusing on the reasons why HCT is necessary and the risks of HCT. However, it is common to encounter clinical settings in which the decision as to whether to pursue transplant is less straightforward. The advent of tyrosine kinase inhibitors, such as imatinib, and its successors, changed the decision process for patients with chronic myeloid leukemia (CML), eventually leading to a dramatic drop in HCT for CML.