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developed that require smaller doses of chemo and radiation therapies. This enables HSCT to be conducted in the elderly, patients with co-morbid conditions and those who would otherwise be considered too weak to undergo a conventional treatment regimen. Use of “mini-transplant” strategies has so far produced mixed results. “Early results suggest that a greater number of patients relapse using this approach,” Dr. Schiller says. “We do not yet fully understand the reason for this, however, which could be that older people have different kinds of cancer. They certainly have more resistant leukemia, in general, than younger people.” Patients with severe organ dysfunction, those on dialysis and people for whom no donor can be identified are still not appropriate candidates for allogeneic HSCT. In addition, HSCT has not demonstrated effi cacy in the treatment of many solid tumors (breast, lung or colon cancer, for example). Despite its current limitations, HSCT will continue to expand beyond the cancer care continuum, according to Dr. Schiller, including the treatment of autoimmune and other diseases. “As one of the oldest and largest transplant centers in the region, we have seen very favorable outcomes using HSCT,” Dr. Schiller says. “We will use our broad experience and lessons learned as we continue to build the evidence base for this and related techniques, but we need more available donors so that we can help more patients.” 11 UCLA Physicians Update