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Nonmyeloablative allogeneic stem-cell transplantation for hematologic malignancies: a systematic review
Benjamin Djulbegovic1, Jerome Seidenfeld, Claudia Bonnell
1Malignant Hematology Program, H. Lee Moffitt Cancer Center Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA. djulbebm@moffitt.usf.edu
Cancer Control : Journal of the Moffitt Cancer Center
|February 25, 2003
Summary
Nonmyeloablative allogeneic stem-cell transplants (NM-allo-SCTs) show promise for hematologic malignancies, but require further study. Current evidence on mini-transplant efficacy and toxicity is limited by small, heterogeneous studies.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Nonmyeloablative allogeneic stem-cell transplants (NM-allo-SCTs), or "mini-transplants," are increasingly considered for hematologic malignancies.
- The hypothesis is that NM-allo-SCTs offer comparable efficacy to standard allo-SCT with reduced toxicity.
Purpose of the Study:
- To analyze existing evidence on the benefits and harms of "mini-transplants" in managing hematologic malignancies.
- To synthesize outcomes from available literature on NM-allo-SCTs.
Main Methods:
- A systematic review of 23 manuscripts, 1 abstract, and 1 letter reporting mini-transplant outcomes in hematologic malignancies.
- Data compilation from 603 treated patients, including 118 transplants from matched unrelated donors.
- Analysis of small prospective case series, many lacking controls, with heterogeneous reporting of outcomes.
Main Results:
- Transplant-related mortality was 32%, with a 15% relapse rate.
- Observed toxicities included graft-vs-host disease and veno-occlusive disease.
- Aggregate complete remission rate was 45%, with 1-year survival ranging from 30% to 60%.
Conclusions:
- Nonmyeloablative allogeneic stem-cell transplantation is a potentially promising therapy for hematologic malignancies.
- Further disease-specific studies with longer follow-up are necessary to fully evaluate NM-allo-SCTs.
- Current evidence is limited by study heterogeneity and small sample sizes.