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Reduced-Intensity Stem Cell Transplantation

"...whereof a little More than a little is by much too much." King Henry IV, part 1, I, 2

Correspondence: Joseph H. Antin, MD, Dana Farber Cancer Institute, 44 Binney St., Boston MA 02115; phone (617) 632-3667; fax: (617) 632-5175; jantin{at}partners.org

Abstract

The recognition that the immune system can play a major role in the control and cure of transplantable disorders led to the development of reduced-intensity allogeneic transplantation. The notion is that a compromise can be made between the intensity of conditioning and the fostering of graft-versus-host disease/ graft-versus-leukemia (GVHD/GVL), allowing the use of less intense conditioning with concomitantly less intense immediate toxicity. Reduced-intensity conditioning regimens have allowed the application of transplantation to older patients and to patients with underlying medical problems that preclude full-dose transplantation. Clearly, in some settings in which dose intensity is important, reduced-intensity regimens are less useful. However, for diseases that are either indolent, highly susceptible to GVL, or under good control before entering transplantation, this approach appears to have substantial benefits. Although the therapy appears to be valuable, concerns about delayed immune reconstitution and GVHD remain.

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