Canterbury DHB

Context

Introduction

Allogeneic stem cell transplants (SCT) were introduced in the mid 1970s. This followed the demonstration by the Seattle Group led by Prof Donnall Thomas that high intensity chemoradiotherapy followed by an HLA matched sibling SCT could lead to long term survival in patients with end stage acute leukaemia resistant to other forms of treatment.

The term standard allogeneic SCT is used in these guidelines to indicate high intensity SCT schedules that must be followed by an infusion of stem cells. Standard SCT achieves control of malignant disease by a combination of high doses of chemo-radiotherapy, followed by an immunological attack on malignant cells by the established graft.

The application of allogeneic SCT has been limited by the lack of suitable donors although this has been helped by the development of BM donor panels. The standard SCT allogeneic procedure also has significant treatment related mortality (TRM) which has been difficult to reduce below 15-20%.

Reduced intensity conditioning (RIC) allogeneic stem cell transplants have been introduced in an attempt to reduce TRM by combining some anti tumour effect and immunosuppression by the conditioning treatment with a graft immunological effect against tumour cells. By making the procedure safer it can be offered to a wider range of patients including older patients. Most standard allografts are not recommended to patients over 40-50 whereas RIC allogeneic SCT is being carried out up to the age of 50-60 or older.

Further reading:

About this Canterbury DHB document (8875):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

December 2016

Next Review:

December 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 8875