Nonmyeloablative allogeneic stem cell transplantation for the treatment of XXXX in first chronic phase.

@entity1 @entity137 @entity3118 @entity205 @entity2132 @entity1863 @entity1499 @entity1860 @entity3894
Reduced-intensity or nonmyeloablative stem cell transplantation (NST) is designed to induce host-versus-graft tolerance by engraftment of donor stem cells. The rationale behind NST is to induce @entity2132 (GVL) effects for elimination of all malignant cells by donor alloreactive immunocompetent cells as an alternative to standard high-dose myeloablative chemoradiotherapy. NST based on the use of @entity3118 , low-dose @entity1863 , and anti-T-lymphocyte globulin (ATG) was employed in 24 @entity1 aged 3 to 63 years with @entity1860 ( @entity1860 ) in first chronic phase (CP). @entity2132 ( @entity2132 ) prophylaxis consisted of low-dose @entity205 (CSP), in some cases with low-dose @entity1499 . Early discontinuation of CSP was attempted in cases of mixed chimerism in an attempt to amplify GVL effects. All 24 @entity1 showed rapid 3-lineage engraftment, mostly without complete @entity3894 ; 6 @entity1 did not require transfusion of any blood products. NST was associated with minimal procedure-related @entity137 . The incidence of acute @entity2132 (grade I or higher) was 54%; however, this incidence increased following CSP withdrawal. After a follow-up of up to 70 months (median, 42 months), 21 of 24 @entity1 remained alive and disease free. The GVL effects induced by donor immunocompetent lymphocytes eradicated all host hematopoietic cells, as evidenced by molecular testing. The Kaplan-Meier probability of survival and disease-free survival at 5 years is 85% +/- 8% (95% confidence interval, 70%-100%). NST may successfully replace myeloablative stem cell transplantation, providing a safer, well-tolerated therapeutic option for all @entity1 with @entity1860 in first CP with a matched donor. However, this conclusion must be tested in a prospective randomized clinical trial.
