Abstract:
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Patients with chronic myeloid leukemia may go through a chronic phase, accelerated phase and blast crisis. While they are in early chronic phase, there are a few targeted therapies that can bring their disease under control without causing severe toxicities. At this time, when the risk of death is low, stem cell transplant, which is potentially dangerous, may not be a good option. However, by the time of blast crisis, when the risk of death is very high, it might be too late to receive a transplant. Then a natural question is that, during this process, when is the best time for transplant? We answer this question by analyzing the patients diagnosed after the year 2001. Some of them never received a transplant, other received transplant during different disease stages, with different types of donors, including siblings, well-matched or partially-matched non-siblings, and other types. The identification of the optimal timing, accounting for patient status and the availability of donor types, is important for guiding clinical practice. Various statistical methods are used for these data analyses, including multistate Markov model, g-estimation, and also dynamic prediction models.
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