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KMID : 0338420090240040287
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The Korean Journal of Internal Medicine
2009 Volume.24 No. 4 p.287 ~ p.298
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Graft-versus-Leukemia Effect of Nonmyeloablative Stem Cell Transplantation
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Imamura Masahiro
Tanaka Junji
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Abstract
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Nonmyeloablative stem cell transplantation (NST) is increasingly used with beneficial effects because it can be
applied to older patients with hematological malignancies and those with various complications who are not
suitable for conventional myeloablative stem cell transplantation (CST). Various conditioning regimens differ in
their myeloablative and immunosuppressive intensity. Regardless of the type of conditioning regimen, graftversus-
host disease (GVHD) in NST occurs almost equally in CST, although a slightly delayed development of
acute GVHD is observed in NST. Although graft-versus-hematological malignancy effects (i.e., graft-versusleukemia
effect, graft-versus-lymphoma effect, and graft-versus-myeloma effect) also occur in NST, completely
eradicating residual malignant cells through allogeneic immune responses is insufficient in cases with rapidly
growing disease or uncontrolled progressive disease. Donor lymphocyte infusion (DLI) is sometimes combined to
support engraftment and to augment the graft-versus-hematological malignancy effect, such as the graft-versusleukemia
effect. DLI is especially effective for controlling relapse in the chronic phase of chronic myelogenous
leukemia, but not so effective against other diseases. Indeed, NST is a beneficial procedure for expanding the
opportunity of allogeneic hematopoietic stem cell transplantation to many patients with hematological
malignancies. However, a more sophisticated improvement in separating graft-versus-hematological malignancy
effects from GVHD is required in the future.
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KEYWORD
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Nonmyeloablative stem cell transplantation, Graft-versus-host disease, Graft-versus-leukemia effect
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