Pushing the envelope-nonmyeloablative and reduced intensity preparative regimens for allogeneic hematopoietic transplantation

被引:23
|
作者
Pingali, S. R. [1 ]
Champlin, R. E. [1 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat & Cellular Therapy, Houston, TX 77030 USA
关键词
STEM-CELL TRANSPLANTATION; ACUTE MYELOID-LEUKEMIA; ACUTE LYMPHOBLASTIC-LEUKEMIA; VERSUS-HOST-DISEASE; BONE-MARROW-TRANSPLANTATION; 1ST COMPLETE REMISSION; CHRONIC LYMPHOCYTIC-LEUKEMIA; TERM-FOLLOW-UP; ACUTE MYELOGENOUS LEUKEMIA; TOTAL-BODY IRRADIATION;
D O I
10.1038/bmt.2015.61
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
Allogeneic hematopoietic cell transplantation (HCT) was originally developed to allow delivery of myeloablative doses of chemotherapy and radiotherapy. With better understanding of disease pathophysiology, the graft vs malignancy (GVM) effect of allogeneic hematopoietic transplantation and toxicities associated with myeloablative conditioning (MAC) regimens, the focus shifted to developing less toxic conditioning regimens to reduce treatment-related morbidity without compromising survival. Although HCT with MAC is preferred to reduced intensity conditioning (RIC) for most patients <= 60 years with AML/myelodysplastic syndrome and ALL, RIC and nonmyeloablative (NMA) regimens allow HCT for many otherwise ineligible patients. Reduced intensity preparative regimens have produced high rates of PFS for diagnoses, which are highly sensitive to GVM. Relapse of the malignancy is the major cause of treatment failure with RIC/NMA HCT. Incorporation of novel agents like bortezomib or lenalidomide, addition of cellular immunotherapy and use of targeted radiation therapies could further improve outcome. In this review, we discuss commonly used RIC/NMA regimens and promising novel regimens.
引用
收藏
页码:1157 / 1167
页数:11
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