title: Reducing transplant toxicity.
abstract: Conventional myeloablative allogeneic hematopoietic cell transplantation produces considerable morbidity and mortality. These generally limit this treatment to patients in good medical condition who are younger than 55 years of age. T-cell-mediated graft-versus-tumor effects play a key role in the elimination of malignancy after allografting. Several investigators have sought to reduce regimen-related toxicities while optimizing graft-versus-tumor effects. Strategies can be broadly classified as (1) reduced-intensity regimens that retain some toxicity, and (2) minimally myelosuppressive regimens that rely on immunosuppression for allogeneic engraftment and resultant graft-versus-tumor effects. Although follow-up has been short, preliminary results are encouraging. Current challenges include defining a regimen that will facilitate full donor engraftment while minimizing toxicities and graft-versus-host disease. If long-term efficacy is demonstrated, such strategies will expand the options for patients who would not qualify for conventional allogeneic transplants.
authors.affiliation: Program in Transplantation Biology, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
authors.forename: L
authors.initials: L
authors.lastname: Feinstein
authors.forename: R
authors.initials: R
authors.lastname: Storb
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000592:standards / Q000633:toxicity; D020350:Graft vs Tumor Effect / Q000187:drug effects / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000592:standards* / Q000639:trends; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000276:immunology / Q000592:standards
chemical_list: D000970:Antineoplastic Agents