Nonmyeloablative preparative regimens for allogeneic hematopoietic transplantation. Biology and current indications.
High-dose myeloablative therapy with allogeneic hematopoietic transplantation is an effective treatment for hematologic malignancies, but this approach is associated with a high risk of complications. The use of relatively nontoxic, nonmyeloablative, or reduced-intensity preparative regimens still allows engraftment and the generation of graft-vs-malignancy effects, is potentially curative for susceptible malignancies, and reduces the risk of treatment-related morbidity. Two general strategies along these lines have emerged, based on the use of (1) immunosuppressive chemotherapeutic drugs, usually a purine analog in combination with an alkylating agent, and (2) low-dose total body irradiation, alone or in combination with fludarabine (Fludara).
Champlin
Richard
R
Department of Blood and Marrow Transplantation, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. rchampli@mdacc.tmc.edu
Khouri
Issa
I
Anderlini
Paolo
P
De Lima
Marcos
M
Hosing
Chitra
C
McMannis
John
J
Molldrem
Jeffrey
J
Ueno
Naoto
N
Giralt
Sergio
S
D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D020350:Graft vs Tumor Effect; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009369:Neoplasms / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation
D018906:Antineoplastic Agents, Alkylating; D007166:Immunosuppressive Agents