Non-Myeloablative Allogeneic Transplantation, 2002 Cancer Treatment and Research Series, Vol. 110

Non-myeloablative allogeneic stem cell transplantation (also known as mini-transplantation or reduced-intensity conditioning transplantation) is a major advance in the field of hematopoietic transplantation within the last 5 years. This approach uses non-cytotoxic or reduced-intensity cytotoxic therapy to prepare patients for allografting of hematopoietic stem cells and lymphocytes. It has the potential to deliver the potent anti-tumor immunotherapy and bone marrow replacement capacity of allogeneic stem cell transplantation to patients with reduced treatment-related morbidity and mortality. It may also enable allogeneic transplantation in patients who would be considered ineligible for conventional transplants because of co-morbidity or advanced age. However, this approach may necessitate more careful monitoring of post-transplant chimerism and malignant disease-status than is usual with conventional allografting. There is also controversy regarding the best preparative regimen and graft-versus-host disease prophylaxis to use.

1 Development of allogeneic hematopoietic stem cell transplantation (HSCT).- 2 Immunosuppression with limited toxicity: the characteristics of nucleoside analogs and anti-lymphocyte antibodies used in nonmyeloablative hematopoietic cell transplantation.- 3 Mobilization of allogeneic peripheral blood progenitor cells.- 4 Non-myeloblative induction of mixed hematopoietic chimerism: application to transplantation tolerance and hematologicmalignancies in experimental and clinical studies.- 5 Combined use of autografting and non-myeloablative allografting for the treatment of hematologic malignancies and metastatic breast cancer.- 6 Non-myeloablative hematopoietic stem cell transplantation (NST) in the treatment of human malignancies: from animal models to clinical practice.- 7 Non-myeloablative allogeneic hematopoietic transplantation and induction of graft-versus-malignancy.- 8 Outpatient allografting in hematologic malignancies and nonmalignant disorders — applying lessons learned in the canine model to humans.- 9 Non-myeloablative transplants for congenital diseases.