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Allogeneic Stem Cell Transplant with Non-Myeloablative Conditioning

General

An allogeneic stem cell transplantation with non-myeloablative conditioning is currently an option which is still experimental. The method and indication is therefore under constant change.

Conditions:

  • Patient is not appropriate for a conventional allogeneic stem cell transplantation (age, complicated illness, < 70 years).
  • The disease is potentially curable with an allogeneic stem cell transplantation.
  • No CNS involvement from the disease. 
  • Left ventricle ejection fraction ≥ 40 %.
  • No serious disturbances in lung function (need for oxygen supply, DLCO < 30 %, FEV1 < 30%).
  • No serious disturbances of biochemical liver parameters, that is:
    • bilirubin more than 2 fold above the normal limit 
    • ASAT and ALAT more than 4 fold above the normal limit
  • Karnofsky score greater than or equal to 50%.
  • Blood pressure 150/90 with standard hypertension medication.
  • Renal function almost normal.

The principle for this type of treatment is to utilize the anti-tumor effect from the donor's T-lymphocytes (and NK cells). The mechanism for this effect is unclear and the frequency of response varies from disease to disease. The method consists of a conditioning regimen which is strongly immunosuppressive, but not myeloablative, to achieve a mixed and subsequent full T-cell chimerism. When the result is successful, the autologous tumor cells are destroyed by the allogeneic lymphocytes. 

Indications

  • Patients with an HLA-identical relative donor or 10/10 identical unrelated donor, who are not suitable for conventional allogeneic stem cell transplantation. Preferably within diagnosis-specific clinical protocols. Must be reported to EBMT.

Possible diagnoses: 

  • Mantel cell- and follicular lymphoma with recurrence after HMAS and chemosensitive disease
  • Chronic lymphocytic leukemia after unsuccessful chemotherapy, including fludarabine
  • Chronic myeloid leukemia with unsuccessful cytogenetic response to optimal drug therapy
  • Multiple myeloma after HMAS
  • AML in research protocol - patients with potential family donor

Goal

  • Cure the disease.

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