ABSTRACT
High-dose chemo- or chemoradiotherapy followed by allogeneic hematopoietic cell transplantation (HCT) has been recognized as an effective therapy for a number of hematologic malignancies with tumor cells resistant to conventional doses of chemotherapy. Hegenbart et al. analyzed outcome of 122 patients with acute myeloid leukemia ineligible for conventional HCT given allogeneic grafts after 2 Gy Low-dose total body irradiation (TBI) with or without added fludarabine, and postgrafting immunosuppression combining myco-phenolate mofetil (MMF) and cyclosporine (CSP). On the basis of preclinical studies in a canine model, the chapter describes a nonmyeloablative conditioning regimen for allogeneic HCT consisting of 2 Gy TBI given on day 0, with postgrafting immunosuppression combining MMF and CSP. A number of retrospective studies have compared incidences of toxicity and infection after nonmyeloablative versus myeloablative conditioning. Reduced-intensity conditioning and nonmyeloablative regimens have allowed engraftment of allogeneic hematopoietic cells and the development of GVT effects.
