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ΣΤΙΣ ΜΕΤΑΜΟΣΧΕΥΣΕΙΣ
ΜΥΕΛΟΥ ΤΩΝ ΟΣΤΩΝ
Συντονιστής: Ι Αποστολίδης*
Μεταμοσχεύσεις με μειωμένης έντασης
σχήματα προετοιμασίας
Ι Μπαλταδάκης
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SUMMARY
Baltadakis I. Stem Cell Transplantation with Reduced-Intensity Conditioning Regimens. The
recognition of the role of donor immune system in disease control has led in the design of allogeneic
stem cell transplants with reduced intensity conditioning regimens. The underlying principle in reduced
intensity transplantation is replacement of the cytotoxic activity of conditioning by the immune effect
of the graft. By use of reduced intensity conditioning regimens, allogeneic stem cell transplantation has
become feasible in older patients or patients with comorbidities, which are not eligible for conventional
myeloablative therapy. The optimal source of the graft is peripheral blood either from related or volunteer
donors. Engraftment is also achieved by the infusion of unrelated umbilical cord blood. Hematologic
malignancies are the main indication of reduced intensity stem cell transplants, while their application
in solid tumors remains experimental. Outcomes are superior in indolent malignancies which are susceptible
to the immunologic graft-versus-tumor effect, such as chronic lymphocytic leukemia, follicular
lymphoma, and mantle cell lymphoma. Encouraging results have been reported in Hodgkin’s lymphoma
patients with relapse after autologous transplant. Reduced intensity transplantation in myelodysplastic
syndromes and acute myelogenous leukemia is associated with significant reduction in transplant-related
mortality, albeit at the price of increased risk of relapse. Tandem autologous and reduced intensity allogeneic
stem cell transplantation has been studied mainly in multiple myeloma, but has not proved
superior to autologous transplant. Critical unresolved issues in reduced intensity transplantation include
the close association of immune antitumor effect with graft-versus-host disease, delayed immune reconstitution,
and higher incidence of relapse. The role of reduced intensity conditioning needs to be defined
by disease-specific, prospective, randomized trials with direct comparison to myeloablative regimens..
Nosokomiaka Chronika, 71, Supplement, 529-536, 2009.
Key words: Reduced intensity conditioning, Non-myeloablative conditioning, Allogeneic stem cell
transplantation.
* Επιμελητής Α’, Αιματολογικό Τμήμα-Μονάδας Μεταμόσχευσης Μυελού Οστών Γ.Ν.Α. «Ο Ευαγγελισμός»
Επιμελητής Α’, Αιματολογικό Τμήμα-Μονάδας Μεταμόσχευσης Μυελού Οστών Γ.Ν.Α. «Ο Ευαγγελισμός»