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November 2, 2011

Overcoming the Age Barrier in Hematopoietic Stem Cell Transplantation: Progress, but Still a Long Way to Go

JAMA. 2011;306(17):1918-1920. doi:10.1001/jama.2011.1612

Allogeneic hematopoietic stem cell transplantation (HSCT) offers the opportunity for cure among patients with various hematologic malignancies.1 However, until the mid-1990s, allogeneic HSCT had only been offered to relatively young, otherwise healthy patients because it required high-dose chemotherapy and radiation therapy to myeloablate and immune-ablate patients to ensure engraftment.2 Since then, reduced-intensity allogeneic HSCT has been tried, using approximately half the dose of chemotherapy compared with conventional full-intensity allogeneic HSCT.3,4 Reduced-intensity allogeneic HSCT demonstrated that myeloablation was not as necessary as had been thought. This conceptual change created the opportunity to offer allogeneic HSCT to older patients.