Reduced-Intensity Allogeneic Stem Cell Transplantation in Adults and Children with Malignant and Nonmalignant Diseases: End of the Beginning and Future.

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DR. YETUNDE T. ISRAEL-AINA PAEDIATRICIAN, UNIVERSITY OF BENIN TEACHING HOSPITAL, BENIN CITY BENIN BLOOD AND MARROW TRANSPLANT WORKSHOP, UNIVERSITY OF BENIN.

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Reduced-Intensity Allogeneic Stem Cell Transplantation in Adults and Children with Malignant and Nonmalignant Diseases: End of the Beginning and Future Challenges Prakash Satwani, Lauren Harrison, Erin Morris, Gustavo Del Toro, Mitchell S. Cairo Biology of Blood and Marrow Transplantation Volume 11, Issue 6, Pages 403-422 (June 2005) DOI: 10.1016/j.bbmt.2005.04.002 Copyright © 2005 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 The most widely used preparative regimens in nonmyeloablative stem cell transplantation and conventional transplantations. The aggressiveness of the underlying malignancy and the donor-recipient genetic disparity, the recipient’s immunocompetence, and sensitization are important in the decision-making process for each clinical situation. MUD indicates matched unrelated donor; CLL/LGL, chronic lymphocytic leukemia/low-grade lymphoma; CML, chronic myelogenous leukemia; LCL, large-cell lymphoma; AML, acute myelogenous leukemia; MM, multiple myeloma; F-TBI 2 Gy, fludarabine and total body irradiation (TBI) 2 Gy; FlagIda, fludarabine, cytosine arabinoside, and idarubicin; MF, melphalan and fludarabine; BEAM, carmustine, etoposide, cytosine arabinoside, and melphalan; Bu8/F/ATG, busulfan 8 mg/m2, fludarabine, and antithymocyte globulin; TBI+Cy, TBI and cyclophosphamide; TBI+F+TT, TBI, fludarabine, and thiotepa; Bu 16/Cy, busulfan 16 mg/m2 and cyclophosphamide; Bu/Flu, busulfan (escalated doses) and fludarabine. *The immunosuppression required depends on the genetic disparity, immunocompetence, and sensitization of the recipient. Reprinted with permission from Elsevier Ireland Ltd [17]. Biology of Blood and Marrow Transplantation 2005 11, 403-422DOI: (10.1016/j.bbmt.2005.04.002) Copyright © 2005 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Kaplan-Meier survival estimates of overall and progression-free survival for 18 patients with de novo or secondary AML in CR1 after nonmyeloablative SCT (2 Gy of total body irradiation with or without 90 mg/m2 of fludarabine). Reprinted with permission from Blackwell Publishing [30]. Biology of Blood and Marrow Transplantation 2005 11, 403-422DOI: (10.1016/j.bbmt.2005.04.002) Copyright © 2005 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Kaplan-Meier survival estimates for 30 patients with CML conditioned with low-dose single-exposure total body irradiation. Reprinted with permission from the American Society for Blood and Marrow Transplantation [40]. Biology of Blood and Marrow Transplantation 2005 11, 403-422DOI: (10.1016/j.bbmt.2005.04.002) Copyright © 2005 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Kaplan-Meier estimate of actuarial survival after allografts according to the number of prior myeloablative autologous SCTs and disease status. Patients with responsive disease (RD; including CR and partial response) receiving 1 myeloablative autologous SCT before RI AlloSCT had significantly better event-free survival and OS compared with patients with progressive disease (PD) and/or ≥2 myeloablative autologous SCTs. Reprinted with permission from the American Society of Clinical Oncology [59]. AT indicates autologous SCT. Biology of Blood and Marrow Transplantation 2005 11, 403-422DOI: (10.1016/j.bbmt.2005.04.002) Copyright © 2005 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 Cumulative incidences of acute GVHD after nonmyeloablative conditioning compared with myeloablative conditioning. A, Related donor transplantation. B, Unrelated donor transplantation. Reprinted with permission from the American Society of Hematology [117]. Biology of Blood and Marrow Transplantation 2005 11, 403-422DOI: (10.1016/j.bbmt.2005.04.002) Copyright © 2005 American Society for Blood and Marrow Transplantation Terms and Conditions