Harnessing graft‐versus‐malignancy: non‐myeloablative preparative regimens for allogeneic haematopoietic transplantation, an evolving strategy for adoptive immunotherapy

Champlin, Richard E.; Khouri, Issa F.; Shimoni, Avichai; Gajewski, James; Kornblau, Steven M.; Molldrem, Jeffrey J.; Ueno, Naoto T.; Giralt, Sergío; Anderlini, Paolo

doi:10.1111/j.1365-2141.2000.02196.x

Cited by 27 publications

(23 citation statements)

References 126 publications

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“…Four evidence-based principles associated with successful NST engraftment include: 1) a conditioning regimen with sufficient immunoablation to overcome residual host immunity not eradicated by the less intense regimen;2,4,17,18 2) allowing host and donor hematopoietic cells to co-exist;17 3) higher stem cell and lymphocyte dose to facilitate engraftment;2,17,18 and 4) dependence on immune reactivity, versus the conditioning regimen, to control residual disease 2,4,17…”

Section: Engraftment Kineticsmentioning

confidence: 99%

“…NMC does not eradicate hematopoiesis and recipient immunity, thus autologous recovery occurs within 28 days should engraftment fail 2,4. RIC, while not fully ablative, results in prolonged bone marrow aplasia should donor engraftment fail 2,4. In a review of 39 studies, 28 different conditioning regimens were documented (Table 3).…”

Section: Regimen Intensity and Stem Cell Sourcesmentioning

confidence: 99%

“… Data from ref 4-9. Champlin et al 2000, Childs et al 1999, McCann et al 2005, Khan et al 2004, Battiwalla et al 2001.…”

Section: Tablesmentioning

confidence: 99%

“…NST includes the use of nonmyeloablative conditioning (NMC) or reduced intensity conditioning (RIC) that consists of low dose chemo- and/or radio-therapy thus decreasing regimen-related toxicity 4. The less intense regimens are generally better tolerated by those normally excluded from conventional myeloablative transplantation, while maintaining engraftment of the donor-derived hematopoietic stem cells and the unique benefit of an immune effect against residual disease (Table 1).…”

mentioning

confidence: 99%

“…The less intense regimens are generally better tolerated by those normally excluded from conventional myeloablative transplantation, while maintaining engraftment of the donor-derived hematopoietic stem cells and the unique benefit of an immune effect against residual disease (Table 1). 4-9…”

mentioning

confidence: 99%

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Non-Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation

Shelburne¹,

Bevans²

2009

Seminars in Oncology Nursing

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Objective-To review the literature related to nonmyeloablative stem cell transplantation, and the unique characteristics and patient population to which it applies. Data Sources-Research studies, research and clinical reviews, clinical experienceConclusion-Nonmyeloablative stem cell transplantation has demonstrated effective and safe application in a heterogeneous population not otherwise eligible for an allogeneic transplantation. Although many principles are based on those of conventional myeloablative transplantation, the engraftment kinetics, patient selection and regimen related complications are distinct.Implications for Nursing Practice-Nurses must be knowledgeable about nonmyeloablative stem cell transplantation including the provision of individualized care for a heterogeneous population. This can include non-traditional transplant indications, elderly cancer patients and those with comorbidities. KeywordsRegimen Intensity; Transplant Engraftment; Chimerism; Comorbidities; Elderly Allogeneic hematopoietic stem cell transplantation (HSCT) is a treatment option with curative potential for patients with malignant, non-malignant, and genetically determined hematologic diseases. 1 Conventional myeloablative transplantation includes myeloablative conditioning with high dose chemo-and radio-therapy to eradicate residual disease and recipient (host) immunity in preparation for healthy donor-derived hematopoietic stem cells (graft). The graft not only provides bone marrow reconstitution, but has an added benefit when the donor-derived lymphocytes mount a specific immune response to eradicate residual disease initially labeled the graft versus leukemia (GVL) effect. Despite these obvious benefits, the regimen related toxicity from the myeloablative conditioning makes conventional myeloablative transplantation a high risk treatment option for the majority of patients with hematologic malignancies due to older age, comorbidities, and an extensive treatment history. 2 Nonmyeloablative allogeneic stem cell transplantation (NST) has emerged as an alternative to conventional myeloablative transplantation. 3 NST includes the use of nonmyeloablative conditioning (NMC) or reduced intensity conditioning (RIC) that consists of low dose chemoand/or radio-therapy thus decreasing regimen-related toxicity. 4 The less intense regimens are

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