Abstract
A second meeting on reduced intensity allogeneic stem cell transplants (RI-HSCT) was convened in Zurich in February 2001 and focused on transplant-related mortality (TRM) and graft-versus-host disease (GVHD). Retrospective and prospective studies from the EBMT, national groups and single institutions included over 900 patients: the incidence of acute GVHD grade III–IV was 12% (1–17%), extensive chronic GVHD 42% (25–51%) and TRM 20% (14–38%). Conditioning regimens could be classified into four major groups based on (1) total body irradiation (TBI) 200 cGy, (2) busulfan 8 mg/kg, (3) thiotepa 10 mg/kg, and (4) melphalan 140 mg/m2: most of these regimens are given in association with fludarabine in different doses and use mobilized peripheral blood as a source of stem cells. The incidence of TRM is similar if not identical for all four regimens, whereas the risk of acute GVHD and chronic GVHD may vary with different protocols. Reduced intensity transplant programs are being explored in patients above the age of 60 and in patients with solid tumors: encouraging results are being recorded in individual patients. Overall these data confirm that allogeneic HSCT can be performed in elderly patients, although a TRM of approximately 15% must be expected and is age dependent. A high rate of extensive chronic GVHD is seen and should be followed carefully. The term mini- or micro-transplant is probably misleading and one should refer to this procedure as an allogeneic HSCT and further classify the intensity of the conditioning regimen.
Bone Marrow Transplantation (2002) 29, 191–195 doi:10.1038/sj.bmt.1703355
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Bacigalupo A . Hematopoietic stem cell transplants after reduced intensity conditioning regimen (RI-HSCT): report of a workshop of the European Group for Blood and Marrow Transplantation (EBMT) Bone Marrow Transplant 2000 25: 803 805
Khouri IF, Keating M, Korbling M et al. Transplant lite: induction of graft versus malignancy using fludarabine based non ablative chemotherapy and allogeneic blood progenitor cell transplantation as treatment for lymphoid malignances J Clin Oncol 1998 16: 2817 2824
Storb R, Yu C, Sanmeier BM et al. Mixed hemopoietic chimerism after marrow allografts. Transplantation in the ambulatory care setting Ann NY Acad Sci 1999 872: 372 375
Slavin S, Nagler A, Naparstek E et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases Blood 1998 91: 756 763
Aversa F, Tabilio A, Terenzi A et al. Successful engraftment of T-cell-depleted haploidentical ‘three-loci’ incompatible transplants in leukemia patients by addition of recombinant human granulocyte colony-stimulating factor-mobilized peripheral blood progenitor cells to bone marrow inoculum Blood 1994 84: 3948 3955
Aversa F, Tabilio A, Velardi A et al. Treatment of high-risk acute leukemia with T-cell-depleted stem cells from related donors with one fully mismatched HLA haplotype New Engl J Med 1998 339: 1186 1193
Bacigalupo A, van Lint MT, Valbonesi M et al. Thiotepa cyclophosphamide followed by granulocyte colony-stimulating factor mobilized allogeneic peripheral blood cells in adults with advanced leukemia Blood 1996 88: 353 357
Raiola AM, van Lint MT, Lamparelli T et al. Reduced intensity thiotepa–cyclophosphamide conditioning for allogeneic hemopoietic stem cell transplants (HSCT) in patients up to 60 years of age Br J Haematol 2000 109: 716 721
Busca A, Bosi A, van Lint MT et al. Transplant-related mortality (TRM) in patients receiving reduced versus conventional intensity thiotepa–cyclophosphamide (THIO-CY) conditioning: the impact of stem cell source in 176 consecutive patients allografted from HLA-identical siblings Bone Marrow Transplant 2001 27: S282
Corradini P, Bregni M, Tarella C et al. Allografting for high-risk hematological and solid tumors: reduced intensity chemotherapy followed by the reinfusion of lymphocytes engineered with thymidine kinase (TK) gene Bone Marrow Transplant 2000 25: S134
Kottaridis PD, Chakraverty R, Milligan DW et al. A non-myeloablative regimen for allogeneic stem cell transplantation with a low incidence of GVHD Bone Marrow Transplant 2000 25: S26
Uberti J, Ayash L, Reynolds C et al. Lower intensity of preparative regimen for allogeneic stem cell transplantation from related donor in patients with advanced hematologic malignancy is associated with poor outcome Blood 2000 96: 201a (Abstr.)
Nagler A, Aker M, Or R et al. Low-intensity conditioning is sufficient to ensure engraftment in matched unrelated bone marrow transplantation Exp Hematol 2001 29: 362 370
Lazarus H, Curtin P, Devine S et al. Role of mesenchymal stem cells (MSC) in allogeneic transplantation: early phase I clinical results Blood 2000 96: 392a (Abstr.)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bacigalupo, A. Second EBMT Workshop on reduced intensity allogeneic hemopoietic stem cell transplants (RI-HSCT). Bone Marrow Transplant 29, 191–195 (2002). https://doi.org/10.1038/sj.bmt.1703355
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1703355
Keywords
This article is cited by
-
Paediatric reduced intensity conditioning: analysis of centre strategies on regimens and definitions by the EBMT Paediatric Diseases and Complications and Quality of Life WP
Bone Marrow Transplantation (2015)
-
Recent Advances in Transplantation for Primary Immune Deficiency Diseases: A Comprehensive Review
Clinical Reviews in Allergy & Immunology (2014)
-
Allogeneic cord blood transplantation for adult acute lymphoblastic leukemia: retrospective survey involving 256 patients in Japan
Leukemia (2012)
-
Long-term disease-free survival after nonmyeloablative cyclophosphamide/fludarabine conditioning and related/unrelated allotransplantation for acute myeloid leukemia/myelodysplasia
Bone Marrow Transplantation (2010)
-
Allogeneic hematopoietic cell transplantation for metastatic breast cancer
Bone Marrow Transplantation (2008)