Reducedintensity Stem Cell Transplantation

The desire to reduce transplant-related mortality, the effectiveness of donor lymphocyte infusions, and evidence in canine models that low doses of TBI provide sufficient immunosuppression to permit engraftment of histocompatible donor hematopoietic cells6061 led to the development and application of reduced intensity regimens in CML.62-64 Although treatment was initially restricted to patients whose age or co-morbidities placed them at high risk for complications, present studies are designed to evaluate their effectiveness in a broader range of patients.

Reduced-intensity regimens result in less acute toxi-city and reduced regimen-related morbidity and mor-tality.62-66 However, the incidence of severe GVHD may be similar to that seen with myeloablative regimens.65-67 Graft rejection68 69 and relapse occur more frequently,65 66 68-70 while infectious complications occur at a similar rate.66 68 71 These regimens permit allogeneic transplantation of individuals who would not be considered good candidates for myeloablative transplantation. Their widespread application requires further investigation.

0 0

Post a comment