Introduction

The term "reduced intensity" conditioning (RIC) is used to describe regimens which are less myelotoxic than conventional intensity myeloablative conditioning, usually result in reversible myelosuppression within 28 days without stem cell support, result in mixed chimerism in a proportion of patients at first assessment and have lower rates of non-haematological toxicity.

A second definition used by the CIBMTR in retrospective analyses defines RIC as a regimen containing <500 cGy single dose or <800 cGy fractionated TBI, <9 mg/kg oral busulphan (or IV equivalent), <140 mg/m² melphalan, <10 mg/kg thiotepa, and the BEAM regimen (Giralt, Ballen et al. 2009).

Confusion over terminology sometimes arises because most RIC regimens still produce significant myelosuppression but there are some which result in no or very little myelosuppression. Both can be referred to as "reduced intensity" but the latter are more accurately described as "non-myeloablative".

There is general agreement that a RIC allograft does have a lower treatment related mortality (TRM) compared to standard allograft. However this is to some extent balanced by a lower anti tumour effect from the less intensive conditioning. Infection and GvHD remain significant risks to the patient, but there is evidence that any anti tumour effect is closely linked to the presence of chronic GvHD.


About this Canterbury DHB document (8885):
Document Owner:	Andrew Butler (see Who's Who)
Last Reviewed:	December 2016
Next Review:	December 2018
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Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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