Korean J Intern Med.  2009 Dec;24(4):287-298. 10.3904/kjim.2009.24.4.287.

Graft-versus-Leukemia Effect of Nonmyeloablative Stem Cell Transplantation

• Imamura M
• Tanaka J

• KMID: 1776655
• DOI: http://doi.org/10.3904/kjim.2009.24.4.287

Abstract

Nonmyeloablative stem cell transplantation (NST) is increasingly used with beneficial effects because it can be applied to older patients with hematological malignancies and those with various complications who are not suitable for conventional myeloablative stem cell transplantation (CST). Various conditioning regimens differ in their myeloablative and immunosuppressive intensity. Regardless of the type of conditioning regimen, graft-versus- host disease (GVHD) in NST occurs almost equally in CST, although a slightly delayed development of acute GVHD is observed in NST. Although graft-versus-hematological malignancy effects (i.e., graft-versus-leukemia effect, graft-versus-lymphoma effect, and graft-versus-myeloma effect) also occur in NST, completely eradicating residual malignant cells through allogeneic immune responses is insufficient in cases with rapidly growing disease or uncontrolled progressive disease. Donor lymphocyte infusion (DLI) is sometimes combined to support engraftment and to augment the graft-versus-hematological malignancy effect, such as the graft-versus-leukemia effect. DLI is especially effective for controlling relapse in the chronic phase of chronic myelogenous leukemia, but not so effective against other diseases. Indeed, NST is a beneficial procedure for expanding the opportunity of allogeneic hematopoietic stem cell transplantation to many patients with hematological malignancies. However, a more sophisticated improvement in separating graft-versus-hematological malignancy effects from GVHD is required in the future.

Keyword

Nonmyeloablative stem cell transplantation; Graft-versus-host disease; Graft-versus-leukemia effect

MeSH Terms

Antigen-Presenting Cells/physiology
Graft vs Host Disease/etiology
*Graft vs Leukemia Effect
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans
Leukemia/therapy
Lymphocyte Transfusion
Lymphoma, Non-Hodgkin/therapy
Multiple Myeloma/therapy
*Transplantation Conditioning