Current status of hematopoietic stem cell transplantation after nonmyeloablative conditioning.
OBJECTIVE
Allogeneic hematopoietic stem cell transplantation was originally developed as a form of rescue from high-dose chemoradiotherapy, which is given both to eradicate malignancy and provide sufficient immunosuppression for allogeneic engraftment. However, it was observed that allogeneic immunocompetent cells transplanted with the stem cells, or arising from them, mediated therapeutic antitumor effects independent of the action of the high-dose therapy. This was termed a graft-versus-tumor effect. This has prompted the recent development of nonmyeloablative conditioning regimens for allogeneic hematopoietic stem cell transplantation that have opened the way to include elderly patients and those with comorbid conditions.


RESULTS
Recent retrospective studies comparing hematopoietic stem cell transplantation after myeloablative or nonmyeloablative regimens suggested that the use of nonmyeloablative conditioning might be associated with lower transplant-related toxicity, lower nonrelapse mortality, and at least similar intermediate-term progression-free survival.


CONCLUSIONS
Hematopoietic stem cell transplantation after nonmyeloablative conditioning might become the procedure of choice also for younger patients. Phase 3 studies are needed to determine outcomes for different diseases and age groups.
Baron
Frédéric
F
Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
Sandmaier
Brenda M
BM
D000818:Animals; D006086:Graft vs Host Disease / Q000517:prevention & control; D020350:Graft vs Tumor Effect; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D019653:Myeloablative Agonists / Q000494:pharmacology / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000379:methods*; D014916:Whole-Body Irradiation
D019653:Myeloablative Agonists