Authors: U Platzbecker G Ehninger N Schmitz M Bornhäuser
Publish Date: 2003/06/21
Volume: 82, Issue: 8, Pages: 463-468
Abstract
Within the past years reduced or modified doses of chemotherapy or radiotherapy have been widely studied for conditioning before allogeneic hematopoietic cell transplantation in patients with myeloid leukemia not eligible for conventional transplantation The main goal was to reduce the substantial treatmentrelated mortality in this patient population while preserving the potential curative graftversusleukemia effect This review summarizes results of published trials using reducedintensity conditioning RIC in patients with acute myeloid leukemia AML myelodysplastic syndrome MDS chronic myeloid leukemia CML and myelofibrosis In most of the published trials conditioning contained fludarabine 90–180 mg/m2 in combination with busulfan 4×10 mg/kg melphalan 90–140 mg/m2 or 2–5 Gy total body irradiation TBI Peripheral blood hematopoietic stem cells from related or unrelated donors were used as graft source in most of the studies Posttransplantation immunosuppression consisted of cyclosporine combined with methotrexate or mycophenolate mofetil Although the majority of the patients were above the age of 50 years early treatmentrelated mortality was rather low Nevertheless the rate of clinically significant graftversushost disease GVHD seemed to be comparable to conventional transplants in most of the protocols The outcome differed between trials but diagnosis and disease status pretransplant significantly influenced outcome In summary this approach is feasible and provides access to the curative potential of allogeneic stem cell transplantation for patients with higher age or comorbidities Since the majority of the reports included heterogeneous patient populations mostly with a short followup more and specifically randomized studies are needed to define the role of RIC before allogeneic hematopoietic cell transplantation
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