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Management of tyrosine kinase inhibitors and donor lymphocyte infusions post transplantation for chronic myeloid leukemia: a survey of contemporary practice on behalf of the chronic malignancies working party of the EBMT

April 10, 2026
April 10, 2026 Stem-cell research : nature.com subject feeds

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Abstract

The landscape of Allogeneic Haematopoietic Cell Transplantation (allo-HCT) for Chronic Myeloid Leukaemia (CML) remains dynamic with the advent of tyrosine kinase inhibitors (TKIs). There remains an absence of widely agreed evidence-based guidelines for post-transplant monitoring and relapse management. To evaluate current real-world practices for ‘high risk’ CML, the CML subcommittee of the Chronic Malignancies Working Party (CMWP) of the European Blood and Marrow Transplantation (EBMT) society developed an electronic survey, which was distributed to 39 EBMT-registered transplant centres in April 2024. Centres were chosen based on CML allo-HCT activity. Twenty-three centres (59%) responded, providing clinical perspectives into pre-transplant chemotherapy regimens, TKI use, ABL1 kinase domain mutation analysis, post-transplant monitoring, and their practice regarding sequencing/ integration of TKIs with donor lymphocyte infusions (DLI). Most centres conduct monthly BCR::ABL1 transcript monitoring during the first three months post-transplant, transitioning to quarterly assessments upon achieving a deep molecular response. TKI maintenance is widely adopted across centres, with treatment duration guided by molecular response, and TKIs are generally preferred over DLI for managing molecular relapse. However, DLI remains a valid option for TKI-refractory chronic-phase (CP)-CML relapse. Survey findings illustrate significant heterogeneity in practice, offering insights to inform research aimed at improving allo-HCT outcomes in CML.

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Data regarding the questionnaire responses can be provided by the EBMT CMWP office following a relevant request.

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Authors and Affiliations

  1. Department of Haematology, Sheffield Teaching Hospitals, Sheffield, United Kingdom

    Alexandros Kanellopoulos & Sebastian Francis

  2. EBMT Leiden Study Unit, Leiden, the Netherlands

    Linda Koster

  3. Department of Haematology, Guy’s and St, Thomas’ NHS Foundation Trust, London, UK

    Hugues de Lavallade

  4. Department of Hematology, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology, Barcelona, Spain

    Guillermo Ortí

  5. University Hospital | Basel, Basel, Switzerland

    Jakob Passweg

  6. Imperial College Healthcare NHS Trust, London, UK

    Jane Apperley

  7. University Hospital Tuebingen, Department of Hematology & Oncology, Tübingen, Germany

    Wolfgang Bethge

  8. Internal Medicine I, BMT-Unit, Medical University of Vienna, Vienna, Austria

    Werner Rabitsch

  9. St James Hospital, Leeds, UK

    Jennifer Clay

  10. CHU Bordeaux, Pessac, France

    Edouard Forcade

  11. Freeman Hospital, Newcastle Upon Tyne, UK

    Erin Hurst

  12. Bristol Haematology & Oncology Centre, Bristol, UK

    Caroline Besley

  13. University Hospitals Birmingham, Birmingham, UK

    Francesca Kinsella

  14. King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia

    Mahmoud Aljurf

  15. The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    He Huang

  16. Singapore General Hospital, Singapore, Singapore

    Aloysius Ho

  17. Universitätsklinikum Jena, Klinik für Innere Medizin II, Abteilung für Hämatologie und medizinische Onkologie, Jena, Germany

    Inken Hilgendorf

  18. University Medical Center Groningen (UMCG), Groningen, The Netherlands

    Goda Choi

  19. University Medical Center Hamburg, Hamburg, Germany

    Francis Ayuk

  20. Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland

    Helbig Grzegorz

  21. University Hospital of Muenster, Münster, Germany

    Matthias Stelljes

  22. University Hospital Southampton, Southampton, UK

    Deborah Richardson

  23. Pavlov University, Saint-Petersburg, Russian Federation

    Elena Morozova

  24. University Clinical Center, Gdańsk, Poland

    Witold Prejzner

  25. University Hospital Freiburg, Freiburg, Germany

    Robert Zeiser

  26. Department of Haematology, St. James Hospital, Dublin, Ireland

    Christopher Armstrong

  27. Department of Haematology and Cellular Therapy, University College Hospital, London, UK

    Kavita Raj & Donal P. McLornan

  28. Central Clinical Hospital, The Medical University of Warsaw, Warsaw, Poland

    Joanna Drozd-Sokolowska

  29. Hematology Division and Faculty of Medicine, Hopitaux Universitaires de Geneve, University of Geneva, Geneva, Switzerland

    Yves Chalandon

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Contributions

AK designed the project and authored the manuscript draft. DPM, YC, HdL, GO, LK, SF, KR, JDS, and CA designed the project and provided critical input to the manuscript. JA, JP, WB, WR, JC, EF, EH, CB, FK, MA, HH, AH, IH, GC, FA, HG, MS, DR, EM, WP, and RZ completed the survey, proposed significant improvements, and approved the final version of the manuscript.

Corresponding author

Correspondence to Alexandros Kanellopoulos.

Ethics declarations

Competing interests

AK: AK has received consulting fees from Jazz and travel support from Jazz and Medac. YC: Y.C. has received consulting fees for advisory board from MSD, Novartis, Incyte, BMS, Pfizer, Abbvie, Roche, Jazz, Gilead, Amgen, Astra-Zeneca, Servier, Takeda, Pierre Fabre, Medac; Travel support from MSD, Roche, Novartis, Pfizer, BMS, Gilead, Amgen, Incyte, Abbvie, Janssen, Astra-Zeneca, Jazz, Pierre Fabre, Sanofi all via the institution. DM: DM has received consulting fees for advisory boards and /or speaker fees from Novartis, Abbvie, GSK and BMS. He has also received research funding from Novartis. GO: GO has received consulting fees for advisory board and / or speaker fees from Chiesi, Jazz, MSD, Novartis, Pfizer, Sanofi and Therakos. He has also received travel support from Incyte, Jazz, Novartis, Pfizer and Sanofi. Research funding from Incyte (institutional). JFA: JFA has received consulting fees for advisory boards and /or speaker fees from Ascentage, Incyte, Novartis, Paladin and Terns. She has also received research funding from Incyte and Pfizer. FK: FK has received consulting fees for advisory board and / or speaker fees from Incyte, Sanofi, Vertex, Therakos, and Jazz. FK has received research funding from Gilead. IH has received speaker fees from Amgen, Abbvie, Novartis, Medac and Takeda. She has also received travel support from Amgen, Jazz, Medac, Neovii and Sanofi. GH: GH has received speaker fees from Abbvie, Novartis, Gilaed, Servier, BMS, Pfizer, GSK. The other authors did not state any competing interests relating to this study.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. This was a descriptive study led by the EBMT CMWP, wherein participating transplant centres provided responses reflecting their institutional clinical practices. Centre answers are based on their patient outcomes, and all patients have provided informed consent according to local regulations to report pseudonymized data to the EBMT. As this study was a descriptive survey of institutional clinical practices directed at transplant centres rather than direct interventional human subjects research, formal institutional ethics committee approval was waived.

Additional information

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Kanellopoulos, A., Koster, L., de Lavallade, H. et al. Management of tyrosine kinase inhibitors and donor lymphocyte infusions post transplantation for chronic myeloid leukemia: a survey of contemporary practice on behalf of the chronic malignancies working party of the EBMT. Bone Marrow Transplant (2026). https://doi.org/10.1038/s41409-026-02862-9

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