摘要:

Allogeneic stem cell transplantation is an established treatment modality for a variety of hematologic malignancies. Allografting carries a high risk for complications and toxicities related to the intensive preparative regimen that is traditionally used for pretransplant myeloablation and the graft-versus-host disease–mediated by donor immune cells. Therefore, allogeneic stem cell transplantation has been used only for younger patients with a good performance status, excluding many other potential candidates because of advanced age or comorbid conditions. Nonablative, or reduced-intensity conditioning, for allogenic stem cell transplantation has been proposed as an alternative that would allow exploiting the graft-versus-tumor effect of allogeneic transplantation without the toxicity of myeloablative therapy. After more than five years of cumulative clinical experience, it is now well established that nonmyeloablative stem cell transplantation is a feasible treatment option for patients with suboptimal performance status because it routinely allows stable donor cell engraftment, is associated with low early nonrelapse mortality rates, and in chemosensitive or slow proliferating malignancies can be associated with long-term disease control. Therefore, nonmyeloablative stem cell transplantation has allowed extension of the indications of stem cell transplantation to older and more debilitated patients; however, the optimal approaches and settings for nonmyeloablative stem cell transplantation remain to be defined.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Imatinib mesylate has recently been introduced as an important therapeutic option in chronic myeloid leukemia but its precise role in the management of chronic myeloid leukemia remains to be defined. A risk assessment score for the outcome after allogeneic stem cell transplantation that involves five prognostic features (age, disease stage, donor type, donor–recipient gender combination, and the interval from diagnosis to transplant) has recently been validated and applied to newly diagnosed patients. At present, it is unclear whether this or other prognostic indices can be usefully applied to patients who receive imatinib from diagnosis. From the current data, it would appear that cytogenetic remissions can be achieved in a significant majority of patients, but not all patients respond to imatinib, and some have developed resistance. Furthermore, the durability of the responses remains unknown. For now, the only curative option remains allogeneic stem cell transplantation, and this treatment should continue to be offered to young patients with suitable donors.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID