Authors' objectives:

This study aims to assess the effects of non-myeloablative allografts in patients who are not eligible for myeloablative treatment, and in patients who are not eligible for myeloablative treatment.

Authors' recommendations: The present review updates the original STEER report (search date August 2001), which found no reliable evidence to compare non-myeloablative transplant with other management. The original review found uncontrolled studies that pointed tentatively towards a short term benefit among people who were ineligible for myeloablative transplant. However, reliability is likely to be compromised by publication, selection and reporting biases and conclusions rest on the assumption that prognosis is uniformly poor with other management strategies. The present review does not substantively alter the conclusions of the original review. We have identified further series with similar limitations and three controlled studies, which compared myeloablative with non-myeloablative transplant. Conclusions from these three studies are, however, limited by confounding and other biases. One study suggested that ABO incompatibility may alter the effectiveness of non-myeloablative transplant, although the study method precluded reliable conclusions about size or direction of such effects. The second study found limited evidence that, in people who survive at least 60 days after transplant, non-myeloablative conditioning was associated with decreased platelet and red cell transfusion requirements compared with myeloablative conditioning. However, this result is not informative for commissioning decisions, because it did not assess transfusion requirements in people who died. We found limited evidence from the remaining cohort study that non-myeloablative transplant reduced infection-related mortality compared with myeloablative transplant. However, results are likely to have been confounded by baseline differences between groups and differences in anti-infection prophylaxis. We found no reliable evidence to compare non-myeloablative transplants with other management strategies for overall mortality; remission; relapse; rejection, or graft versus host disease.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.wihrd.soton.ac.uk

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: Wessex Institute for Health Research and Development

Contact Address: Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton. SO16 7PX Tel. +44 1703 595661 Fax +44 1703 595662

Copyright: Bazian Ltd, Wessex Institute for Health Research and Development