Should a teenager diagnosed with CML in blast crisis go to transplant once MRD is negative?

I would take the patient to BMT now. Survival of patients who received BMT for blast crisis is dependent on the pre-BMT remission status (Radujkovic et al., PMID 31271884), but I am not aware of data showing benefit of giving consolidation when a patient has negative MRD. Best results of BMT are achieved if the patient returns to chronic phase especially if there is significant cytogenetic or molecular improvement. (Saußele and Silver, PMID 25814082) These are from adult data and there is no data in pediatrics, but the same approach would be warranted.

Usually, the goal of initial management of CML blast crisis is to revert to chronic phase, with plans to proceed with allogeneic hematopoietic cell transplantation (HCT) in chronic phase, if possible.

If the presentation was blast crisis without previous TKI, then I will start with TKI alone and plan for allo-HCT as soon as possible (Cortes et al., PMID 18754032).

Further therapies to revert blast crisis to chronic phase CML differs depending on the lineage of the blasts (i.e., myeloid versus lymphoid).

Survival of patients who received BMT for blast crisis is dependent on the pre-BMT remission status (Radujkovic et al., PMID 31271884).