Lunch Debate at the 11th Congress

Chair: Alois Gratwohl.

In favour of standard allo-HSC transplants: J Apperley.

In favour of reduced intensity conditioning: D Niederwieser.

The debaters discussed the evidence for standard versus reduced intensity transplants (RIC). The audience broadly agreed with Dr Apperley that the evidence at present was in favor of standard allo-HSC transplantation (HSCT) and that there is NO evidence that RIC is superior to standard allo-HSCT.

The philosophy behind RIC is that a reduction in the cytokine storm and a greater reliance on the Graft versus Leukaemia effect will result in a better outcome and widen applications . Undoubtedly the immediate toxicity is reduced but unfortunately there are NO prospective randomized trials to test the hypothesis of a better long-term outcome. Problems remain in determining long-term disease-free survival after RIC as numbers of patients are small and the follow up period is relatively short.

Currently RIC has a place in the treatment of young patients with co-morbidity prohibiting standard allo-HSCT, older (>60yrs) patients and in patients with selected benign haematological disorders such as PNH and perhaps sickle cell disease and thalassaemia.

RIC may also have a role as an adjunct to autologous transplantation in diseases such as multiple myeloma and NHL.

RIC is here to stay but new randomized trials are keenly awaited and results will define the role of RIC more precisely.