Nonmyeloablative And Reducedintensity Conditioning Regimens

The demonstration that an immune-mediated GVL effect plays a central role in the therapeutic efficacy of allogeneic HSCT led to the hypothesis that myeloabla-tive conditioning regimens were not essential for tumor eradication.83 This subsequently led investigators to develop less intense conditioning regimens that were adequately immunosuppressive to permit the engraftment of donor hematopoietic stem cells, and could serve as a platform for the administration of donor T cells as adoptive cellular therapy.84 A variety of nonmyeloablative, also referred to as reduced-intensity, conditioning regimens have been reported.85-88 All share the similar goal of providing sufficient immunosuppression to achieve donor engraftment of an allogeneic hematopoietic stem cell graft while attempting to minimize toxicity. The most important clinical question is whether this reduction in toxicity comes at the cost of a loss of antitumor activity within the conditioning regimen.

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