Allogeneic stem cell transplantation

The use of allogeneic SCT in patients with HES or CEL remains at the exploratory stage and is limited to selected cases with aggressive disease. Successful engraftment using standard myeloablative regimens and disease-free survival between 8 months and 5 years have been reported.114-117 Recently, the concept of nonmyeloablative SCT has been applied to a few HES patients, who achieved engraftment after reduced-intensity conditioning.118119 Follow-up of those patients has not exceeded 12 months, so the potential advantage of this less toxic approach is not yet evident. Nonmyeloablative SCT is worth attempting in selected symptomatic patients who fail standard treatments, including imatinib mesylate. Because of transplantation-related complications (e.g., serious infections and acute or chronic graft-ver-sus-host disease), and the likely bias inherent in patient selection, the major challenge will be to determine the benefit of SCT in a limited number of candidates for this treatment.

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