title: Nonmyeloablative allogeneic stem-cell transplantation for hematologic malignancies: a systematic review.
abstract: BACKGROUND
  Increasingly, clinicians advocate the use of nonmyeloablative allogeneic stem-cell transplants (NM-allo-SCTs, "mini-transplants") to manage hematologic malignancies. They hypothesize that NM-allo-SCT is equally efficacious to standard allo-SCT but produces less regimen-related toxicity.
  
  
  METHODS
  To analyze available evidence on the benefits and harms of "mini-transplants," we identified 23 manuscripts, 1 abstract, and 1 letter that reported the outcome of mini-transplants in hematologic malignancies.
  
  
  RESULTS
  Data were compiled on 603 treated patients, with 118 transplants using stem cells from matched unrelated donors. All studies were small prospective case series, and most lacked concurrent or historical controls. Outcomes of interest were not uniformly reported. The studies were heterogeneous and used different patient selection criteria, conditioning regimens, and timing of transplant with respect to disease status. The transplant-related mortality rate was 32%, the relapse rate was 15%, and toxicities included acute and chronic graft-vs-host disease and veno-occlusive disease. The aggregate rate of complete remission was 45%. Survival at 1 year or longer ranged from 30% to 60% at 1 to 5 years of follow-up. All studies reported successful chimerism.
  
  
  CONCLUSIONS
  Disease-specific studies with longer follow-up are needed to evaluate this potentially promising therapy.
authors.affiliation: Malignant Hematology Program, H. Lee Moffitt Cancer Center Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA. djulbebm@moffitt.usf.edu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Djulbegovic
authors.forename: Jerome
authors.initials: J
authors.lastname: Seidenfeld
authors.forename: Claudia
authors.initials: C
authors.lastname: Bonnell
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
mesh_terms: D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D007165:Immunosuppression Therapy; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D014184:Transplantation, Homologous