Indications and outcomes of reduced-toxicity hematopoietic stem cell transplantation in adult patients with hematological malignancies

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Abstract

Hematopoietic stem cell transplantation (HCT) utilizing non-myeloablative (NMA) and reduced-intensity conditioning (RIC) regimens (collectively referred to as reduced-toxicity HCT, RT-HCT) has become a viable therapeutic option for patients with hematological malignancies who are ineligible for standard myeloablative conditioning transplantation (MA-HCT). RT-HCT has been shown to induce stable engraftment with low toxicity, and to produce similar overall and progression-free survival (PFS) when compared to MA-HCT in acute myeloid leukemia and myelodysplastic syndrome. The best results for RT-HCT have been reported for patients with disease that is in remission, indolent and chemosensitive, and with a strong graft-versus-malignancy effect. Chronic graft-versus-host disease seems to correlate with a lower relapse rate and better PFS. RT-HCT is inferior when performed in poor risk or advanced disease, due to high relapse rates. A search for novel strategies that includes the most appropriate conditioning regimens and post-transplant immunomodulation protocols with more intensive anti-malignancy activity but limited toxicity is in progress. This review provides an update on the results of clinical studies of RT-HCT, and discusses possible indications and investigative strategies for improving the clinical outcomes of RT-HCT for the major hematological malignancies.

Original languageEnglish
Pages (from-to)581-598
Number of pages18
JournalInternational Journal of Hematology
Volume97
Issue number5
DOIs
Publication statusPublished - May 2013

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Hematopoietic Stem Cell Transplantation
Hematologic Neoplasms
Disease-Free Survival
Transplantation Conditioning
Transplants
Recurrence
Immunomodulation
Myelodysplastic Syndromes
Graft vs Host Disease
Acute Myeloid Leukemia
Neoplasms
Therapeutics

Keywords

  • Graft-versus-malignancy (GvM)
  • Hematological malignancies (HM)
  • Non-myeloablative (NMA) regimen
  • Reduced-intensity conditioning (RIC)
  • Reduced-toxicity hematopoietic stem cell transplantation (RT-HCT)
  • Transplant-related toxicities (TRT)
  • Transplantation-related mortality (TRM)

ASJC Scopus subject areas

  • Hematology

Cite this

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title = "Indications and outcomes of reduced-toxicity hematopoietic stem cell transplantation in adult patients with hematological malignancies",
abstract = "Hematopoietic stem cell transplantation (HCT) utilizing non-myeloablative (NMA) and reduced-intensity conditioning (RIC) regimens (collectively referred to as reduced-toxicity HCT, RT-HCT) has become a viable therapeutic option for patients with hematological malignancies who are ineligible for standard myeloablative conditioning transplantation (MA-HCT). RT-HCT has been shown to induce stable engraftment with low toxicity, and to produce similar overall and progression-free survival (PFS) when compared to MA-HCT in acute myeloid leukemia and myelodysplastic syndrome. The best results for RT-HCT have been reported for patients with disease that is in remission, indolent and chemosensitive, and with a strong graft-versus-malignancy effect. Chronic graft-versus-host disease seems to correlate with a lower relapse rate and better PFS. RT-HCT is inferior when performed in poor risk or advanced disease, due to high relapse rates. A search for novel strategies that includes the most appropriate conditioning regimens and post-transplant immunomodulation protocols with more intensive anti-malignancy activity but limited toxicity is in progress. This review provides an update on the results of clinical studies of RT-HCT, and discusses possible indications and investigative strategies for improving the clinical outcomes of RT-HCT for the major hematological malignancies.",
keywords = "Graft-versus-malignancy (GvM), Hematological malignancies (HM), Non-myeloablative (NMA) regimen, Reduced-intensity conditioning (RIC), Reduced-toxicity hematopoietic stem cell transplantation (RT-HCT), Transplant-related toxicities (TRT), Transplantation-related mortality (TRM)",
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AB - Hematopoietic stem cell transplantation (HCT) utilizing non-myeloablative (NMA) and reduced-intensity conditioning (RIC) regimens (collectively referred to as reduced-toxicity HCT, RT-HCT) has become a viable therapeutic option for patients with hematological malignancies who are ineligible for standard myeloablative conditioning transplantation (MA-HCT). RT-HCT has been shown to induce stable engraftment with low toxicity, and to produce similar overall and progression-free survival (PFS) when compared to MA-HCT in acute myeloid leukemia and myelodysplastic syndrome. The best results for RT-HCT have been reported for patients with disease that is in remission, indolent and chemosensitive, and with a strong graft-versus-malignancy effect. Chronic graft-versus-host disease seems to correlate with a lower relapse rate and better PFS. RT-HCT is inferior when performed in poor risk or advanced disease, due to high relapse rates. A search for novel strategies that includes the most appropriate conditioning regimens and post-transplant immunomodulation protocols with more intensive anti-malignancy activity but limited toxicity is in progress. This review provides an update on the results of clinical studies of RT-HCT, and discusses possible indications and investigative strategies for improving the clinical outcomes of RT-HCT for the major hematological malignancies.

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KW - Transplantation-related mortality (TRM)

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