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Concepts and Controversies in the Use of Novel Preparative Regimens for Allogeneic Stem Cell Transplantation

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Allogeneic Stem Cell Transplantation

Part of the book series: Contemporary Hematology ((CH))

Abstract

The number of reduced-intensity conditioning (RIC)/nonmyeloablative transplants (NMT) has risen steadily over the last 10 years, now comprising approximately 30% of all allogeneic transplants performed annually [1]. Despite the rapid rise in its application, we have much to learn in terms of optimizing conditioning regimens, GvHD prophylaxis, identifying appropriate patient cohorts, and disease states, thus balancing the critical endpoints of chimerism, GvHD, relapse, and toxicity for the optimal utilization of this strategy.

Building on the landmark work by Storb et al. [2, 3] in the canine model, the paradigm requiring myeloablation of the host immunohematopoietic system for successful long-term donor hematopoietic engraftment, has been replaced by the view that nonmyeloablative allogeneic transplantation is at its essence, the truest form of cellular immunotherapy. At its inception approximately a decade ago, the initial goal was to offer potentially curative treatment to patients previously excluded from consideration for standard allotransplantation secondary to age and/or other comorbid conditions. Early papers in RIC/NMT focused on the critical goals of establishing donor hematopoiesis with low early treatment-related mortality; notably absent was the demonstration of long-term disease control [4]. Whether NMT/RIC can improve on the disease outcomes of standard transplantation as opposed to simply broadening the pool of potential candidates for allotransplantation remains an area of active investigation.

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  1. Division of Hematology-Oncology and Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, PA, USA

    Steven C. Goldstein & Selina Luger

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  1. Steven C. Goldstein
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  1. University Hospitals Case Medical Center, Cleveland, OH, USA

    Hillard M. Lazarus

  2. Case Western Reserve University, Cleveland, OH, USA

    Mary J. Laughlin

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Goldstein, S.C., Luger, S. (2010). Concepts and Controversies in the Use of Novel Preparative Regimens for Allogeneic Stem Cell Transplantation. In: Lazarus, H.M., Laughlin, M.J. (eds) Allogeneic Stem Cell Transplantation. Contemporary Hematology. Humana Press. https://doi.org/10.1007/978-1-59745-478-0_25

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