The expanding applications of non-myeloablative stem cell transplantation

Non-myeloablative preparative strategies for allogeneic stem cell transplantation (SCT) have been increasingly utilized for a variety of hematological malignancies, solid tumours, and for tolerance induction. These regimens are associated with less transplant-related morbidity and mortality than conventional transplant conditioning regimens. It is not yet clear whether graft-vs.-host disease (GVHD) protection is afforded. Potent antitumour responses have been described in a variety of advanced malignancies. We have utilized a cyclophosphamide/anti-T-cell antibody therapy approach, which has resulted in the uniform induction of mixed chimerism. In many cases, this has served as an immunological platform for adoptive cellular immunotherapy (via donor leukocyte infusions). The results of this experience, as well as the outcomes of non-myeloablative stem cell transplantation (NST) for other malignant and nonmalignant conditions are described.