Reduced intensity conditioning for allogeneic hematopoietic stem cell transplantation (HSCT)

Reduced intensity conditioning (RIC) regimens have allowed performing allogeneic haematopoietic stem cell transplantation (HSCT) in patients for whom conventional myeloablative allogeneic HSCT is associated with unacceptable risks of non-relapse-mortality. This approac relies mainly on graft-versus-tumour effects for tumour eradication. Retrospective studies have suggested that, in patients aged 40 to 60 years, RIC-HSCT was associated with a higher risk of relapse but a lower incidence of transplant-related mortality than myeloablative allogeneic HSCT, leading to similar progression-free and overall survivals. After reviewing the rationale for RIC-HSCT, this article discusses the results of RIC-HSCT in specific deseases, and proposes what could be current indications for RIC-HSCT in 2011. Finally, the article briefly presents some possible strategies aimed at increasing the anti-tumoral activity of the procedure while reducing the incidence and severity of acute graft-versus-host disease.