Hematopoietic stem cell transplantation (HSCT) is a commonly used and effective treatment option for a wide range of hematologic malignancies, with approximately 8,000 allogeneic bone marrow transplants performed annually in the United States. The successful engraftment of an allogeneic HSCT requires immunosuppression of the recipient through the use of a preparative regimen. Traditionally, a myeloablative regimen, including chemotherapy with or without total body irradiation (TBI) has been used. While myeloablative therapy can successfully produce engraftment, these regimens impart significant toxicity, limiting their use in patients who are older or have comorbidities. Recently, nonmyeloablative regimens have been investigated that provide sufficient immunosuppression of the recipient, allowing for engraftment and development of the graft-versusmalignancy effect. Nonmyeloablative regimens can include purine analogs combined with an alkylating agent or low-dose TBI. While these regimens appear effective, potential complications include the development of graft-versus-host disease (GVHD) and low donor chimerism. This monograph will focus on updates on the use of nonmyeloablative transplantation in the treatment of hematologic malignancies and the management of potential associated adverse events.

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Release date: May 18, 2006
Expiration date: May 18, 2007