10 Years of Experience with Reduced-Intensity Stem Cell Transplants

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Leukemia (2006) 20, 1661–1672. doi:10.1038/sj.leu.2404334; published

online 27 July 2006

Stem cell transplantation with reduced-intensity conditioning

regimens: a review of ten years experience with new transplant

concepts and new therapeutic agents

A J Barrett1 and B N Savani1

1Hematology Branch, National Heart Lung and Blood Institute, National

Institutes of Health, Bethesda MD, USA

Received 22 March 2006; Revised 15 June 2006; Accepted 19 June 2006;

Published online 27 July 2006.

The realization in the 1990s that allogeneic stem cell transplants

(SCT) have a potentially curative graft-versus-leukemia (GVL) effect

in addition to the antileukemic action of myeloablative conditioning

regimens was a major stimulus for the development of reduced-intensity

conditioning (RIC) regimens, aimed primarily at securing engraftment

to provide the GVL effect, while minimizing regimen-related toxicity.

It is now over 10 years since RIC regimens were heralded as a new

direction in the field of SCT. Over the last decade much has been

learned about the ways in which the conditioning regimen can be

tailored to provide adequate immunosuppression, and modulated to

deliver a chosen degree of antimalignant treatment.

The huge literature of clinical data with RIC transplantation now

permits us to more clearly define the success and limitations of the

approach. This review examines the origins of RIC SCT, explores the

degree to which the initial expectations and purpose of the approach

have been realized, and outlines some ways forward for the field.