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.
- 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.
- 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.
- 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