Info

65%

4.7% (at 100 days)

At a median follow-up of 11.5 months 68% were surviving 52% were surviving free of progression

agrade I—IV; bextensive chronic GvHD

NRM, nonrelapse mortality; 2-CDA, cladribine; ATG, antithymocyte globulin; CSP, cyclosporine; FK506, tacrolimus; MTX, methotrexate; BM, bone marrow; OS, overall survival; DFS, disease-free survival; PFS, progression-free survival; NR, not reported; RIC, reduced-intensity conditioning regimen; NMCR, nonmyeloablative conditioning regimen.

agrade I—IV; bextensive chronic GvHD

NRM, nonrelapse mortality; 2-CDA, cladribine; ATG, antithymocyte globulin; CSP, cyclosporine; FK506, tacrolimus; MTX, methotrexate; BM, bone marrow; OS, overall survival; DFS, disease-free survival; PFS, progression-free survival; NR, not reported; RIC, reduced-intensity conditioning regimen; NMCR, nonmyeloablative conditioning regimen.

Figure 96.2 Nonmyeloablative HCT regimens for patients with malignancies given grafts from HLA-matched related and unrelated donors. (Reprinted from Baron F, Storb R, Little MT: Hematopoietic cell transplantation: five decades of progress. Arch Med Res 34:528-524, 2003; with permission from IMSS.)

of nonmyeloablative conditioning. These include (1) no eradication of host hematopoiesis; (2) prompt hematologic recovery (<4 weeks) without transplant; and (3) presence of mixed chimerism upon engraft-ment. Reduced-intensity conditioning regimens are aimed at eliminating host-versus-graft reactions and producing major antitumor effects. Conversely, non-myeloablative conditioning regimens rely on optimization of pre- and posttransplant immunosuppres-sion to overcome host-versus-graft reactions to allow engraftment, and eradication of tumors depend nearly exclusively on the GvT effect. In patients with slowly progressing diseases [i.e., chronic lymphocytic leukemia (CLL), low-grade non-Hodgkin's lymphoma (NHL), and chronic myeloid leukemia (CML) in first chronic phase] or with more aggressive diseases in complete remission, a nonmyeloablative conditioning regimen might be sufficient to achieve engraftment and cure the malignant disease. However, cytoreduc-tion might be required in patients with aggressive diseases (acute leukemia, multiple myeloma, high-grade lymphoma, Hodgkin's disease), who are not in complete remission at the time of the transplant.

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