Allogeneic Hematopoietic Stem Cell Transplantation with a Nonmyeloablative Conditioning Regimen

The development of nonmyeloablative allogeneic hematopoietic stem cell transplantation (HSCT) from the preclinical studies to the clinic has permitted the treatment of a larger number of patients who previously had not been candidates for the standard approach with myeloablation. This includes older patients and those patients who had contraindications to intensive cytotoxic regimens. Regimen-related toxicities (RRT) after myeloablation result in prolonged periods of hospitalization and the development of significant morbidity and potential mortality including veno-occlusive disease and idiopathic interstitial pneumonitis. Severe RRT can generally be avoided after nonmyeloablative conditioning. A graft-versus-leukemia reaction is critical to the eradication of many hematological malignancies after transplantation and has been shown to be effective in those patients who have been infused with lymphocytes from the donor (DLI) after relapse.