Objective:

To review the rationale for combining radioimmunotherapy (RIT) with reduced-intensity conditioning (RIC) in allogeneic hematopoietic transplantation (allo-HCT) for leukemia, focusing on antigen selection, radionuclide properties, and clinical experiences related to this combination.

Approach:

Key Findings:

• RIT can enhance the efficacy of RIC by delivering targeted radiation to hematopoietic malignancies.
• CD45 is the most studied target for RIT, allowing for specific radiation delivery to leukemia cells.
• Clinical trials indicate that RIT combined with RIC is feasible and can improve disease control.
• Hepatic toxicity is a significant limitation of RIT dosing, necessitating careful organ-specific assessments.

Interpretation:

RIT may improve disease control in RIC allo-HCT without compromising tolerability, but further prospective studies are required to establish its role as a standard component of conditioning.

Limitations:

• Current evidence is primarily from early-phase studies, which limits the generalizability of findings.
• The role of RIT in the evolving therapeutic landscape of AML and related malignancies is still being defined.

Conclusion:

RIT represents a promising approach for targeted cytoreduction in patients with residual disease at the time of transplantation, warranting further investigation.

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