Non-myeloablative allogeneic stem cell transplantation

Several haematological malignancies can be cured using allogeneic stem cell transplantation (SCT). Maximal tolerable chemoradiotherapy doses are given as part of the conditioning-regimen. This treatment causes substantial toxicity, and the procedure is therefore restricted to patients younger than 60 years without co-morbidity. Non-myeloablative allogeneic SCT, is a treatment modality that can be offered to patients up to 70 years of age and to younger patients with co-morbidity. 21 patients (17 men and 4 women) with different haematological malignancies, have been treated with non-myeloablative allogeneic SCT in our institution from October 2000 to May 2005. The transplant procedure was relatively non-toxic. Four patients required transfusions and 3 required empirical antibiotic treatment, which is always necessary after myoablavative allogen SCT. A stable donor chimerism was achieved for most of our patients before day 84. 11 patients suffered from acute graft versus host disease (GVHD), 6 with debut of symptoms after day 100. 11 patients developed chronic GVHD. 14 patients are alive and 7 are dead; 2 due to transplant-related complications and 5 due to disease progression. We have shown that non-myeloablative allogeneic SCT is feasible with an acceptable toxicity. Acute and chronic GVHD is still a substantial problem. Prospective studies with adequate controls are warranted to determine the future role of non-myeloablative allogeneic SCT.