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Transfusions after nonmyeloablative or reduced-intensity conditioning regimens

Leukemia volume 20, pages 2081–2086 (2006)Cite this article

Allogeneic hematopoietic cell transplantation (HCT) following reduced-intensity conditioning (RIC) or nonmyeloablative conditioning has been an effective treatment for many patients with hematological malignancies, as well as for selected patients with solid cancers or inherited blood disorders.

A number of different RIC or nonmyeloablative conditioning regimens have been explored. The separation of what constitutes a nonmyeloablative versus a RIC regimen is somewhat arbitrary (Table 1), although Giralt proposed some criteria for nonmyeloablative conditioning that included (1) no eradication of host hematopoiesis, (2) prompt hematologic recovery (<4 weeks) without transplant and (3) presence of mixed chimerism upon engraftment.1 Similarly, the distinction between RIC and myeloablative conditioning has been discussed; the criteria proposed by Giralt1 included ⩽5 Gy total body irradiation (TBI), ⩽9 mg/kg busulfan dose, ⩽140 mg/m2 melphalan dose and ⩽10 mg/kg thiothepa dose.1 RIC regimens have combined modest doses of fludarabine (used mainly for its immunosuppressive activity) with consequent (but nonmyeloablative) doses of alkylating agents such as melphalan (140 mg/m2)2 or busulfan (4–8 mg/kg),3 given to produce major anti-tumor effects with the hope of controlling the malignancy before the occurrence of the immune-mediated graft-versus-tumor effects. In contrast, nonmyeloablative conditioning has used potent immunosuppressive regimens to overcome host-versus-graft reactions (graft rejection),4, 5 allowing engraftment of donor hematopoietic and immune cells. Thus, following nonmyeloablative conditioning, eradication of both host hematopoiesis and tumor cells is mediated nearly exclusively by immune-mediated graft-versus-host effects.6, 7

Table 1 Commonly used nonmyeloablative or RIC regimens in relation to their myelosuppressive properties8
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  1. Department of Medicine, Division of Hematology, University of Liège, Liège, Belgium

    F Baron, G Vanstraelen & Y Beguin

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Correspondence to Y Beguin.

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Baron, F., Vanstraelen, G. & Beguin, Y. Transfusions after nonmyeloablative or reduced-intensity conditioning regimens. Leukemia 20, 2081–2086 (2006). https://doi.org/10.1038/sj.leu.2404431

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