Concept Of Reducedconditioning Allo

In recent years, reduced conditioning or nonmyeloab-lative conditioning has been used to avoid the toxic effect of the preparative regimen, yet allow donor cell engraftment to take place, and ultimately to result in a GvL effect.38-40 These highly immunosuppressive but less toxic regimens rely upon engraftment and subsequent immunologic effect to eradicate NHL. Diaconescu and colleagues41 at the Fred Hutchinson Cancer Research Center reported in preliminary fashion a retrospective comparison of reduced conditioning versus myeloablative conditioning for NHL patients undergoing HLA-identical allografts. They noted that despite the former group having a higher median age, higher comorbidity index, and greater likelihood of prior allograft, the treatment-related mortality at 100 days was 8.8% compared to 20.6% in the myeloablative group.

Table 65.8 shows five studies describing the data for NHL patients who underwent a reduced-conditioning allo SCT for relapse after an auto SCT.42-46 The information presented reflects either retrospective registry analyses42 or small single institutional studies. Mantle-cell NHL patients appeared to fare poorly in the registry

Table 65.8 Selected studies using reduced-intensity conditioning and allo SCT for NHL relapses after auto SCT

References

No. of patients and NHL

Nonrelapse mortality

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