Nonmyeloablative preparative regimens for allogeneic hematopoietic transplantation

Allogeneic hematopoietic transplantation is an effective therapy for a rang e of malignancies. High doses of myelosuppressive chemotherapy or radiation have been used in preparative regimens with the goal of preventing graft r ejection and eradicating malignancy. Much of the benefit of transplantation , however, results from graft-versus-malignancy effects, mediated by donor immunocompetent cells. An alternative approach is to utilize less toxic, no nmyeloablative preparative regimens to achieve engraftment and allow graft- versus-malignancy effects to develop. This strategy reduces the risk of tre atment-related mortality and allows transplantation for elderly or medicall y infirm patients not eligible for myeloablative therapy. Nonmyeloablative preparative regimens appear promising in diagnoses sensitive to graft-versu s-malignancy effects and provide a platform for further development of cell ular immunotherapy, Controlled clinical trials are warranted to define the role of nonmyeloablative allogeneic transplants in a range of hematologic m alignancies and selected solid tumors.