Reduced-intensity Hematopoietic Stem Cell Transplantation (RIST) for Solid Malignancies

Abstract

Reduced intensity stem cell transplantation (RIST) is a new approach of stem cell transplantation, which has shown promising features as reported in multiple phase I and II studies. Elderly patients, who are not eligible for conventional myeloablative hematopoietic stem cell transplantation (HSCT), are now treatable with RIST. It has also reduced regimen-related toxicity and provided better prognosis in short-term follow-up than conventional HSCT. Among solid tumors, metastatic renal cell carcinoma was found to respond well to RIST. Clinical studies are currently being conducted to evaluate the efficacy of RIST in other types of solid tumors. However, the mechanism of graft-versus-host disease (GVHD) and graft-versus-tumor (GVT) effects remains unclear. More knowledge on the mechanism is crucial to enhance the antitumor effect and to improve the prognosis further.

Intensive multimodality therapy including paclitaxel and reduced-intensity allogeneic hematopoietic stem cell transplantation in the treatment of adrenal cancer with multiple metastases

“…Third, this patient received intensive procedures for local tumor control, including extensive primary tumor resection, TAE/TAI, and proton-beam irradiation, which may have made the tumor more sensitive to a GVT effect, as previously suggested. 11 In summary, successful allogeneic SCT requires a highly integrated program of donor selection, preparative regimen, and management of GVHD. Nevertheless, it is possible that the combination of TIP chemotherapy, intensive local tumor controls, and a GVT effect may have contributed to the prolonged survival of this patient.…”

Novel conditioning regimens for bone marrow transplantation

“…44 Donor lymphocyte infusion performed after these conditioning regimens has shown promising results, even in the treatment of solid malignancies in both animal and clinical studies. 17,45 Thirdly, the defense provided by the host's immune system is partly protected because the reduced-intensity and nonmyeloablative conditioning regimens do not immediately and completely eliminate host-derived immunocompetent cells, and the level of host neutropenia is reduced. This is extremely important for early immunity after transplantation, and infectious complications may be reduced.…”

“…15,16 Therefore, we have put reduced-intensity and nonmyeloablative conditioning regimens together in this review when discussing those regimens that are not myeloablative and are less toxic. [17][18][19] Here, we review the conditioning regimens that are performed as pretreatments for BMT, and focus on some novel conditioning methods (reduced-intensity and nonmyeloablative conditioning regimens) with lower intensity that have expanded the use of BMT to older patients and to those with comorbidities.…”