نبذة مختصرة : Both in haematological malignancies and in disseminated solid tumours, re-occurrence of the underlying disease is the main complication. Allogeneic haematopoietic stem cell transplantation (HSCT) increases the chance of cure compared to only chemotherapy in haematological malignancies, but adds the risk of immunological complications such as graft-versus-host disease (GVHD) and severe infections. Immunosuppressive treatment is needed to prevent rejection of the graft and GVHD. The reason for lower relapse incidence after allogeneic HSCT has been attributed to a graft-versus-leukaemia (GVL) effect, which has also been suggested to be present against solid tumours after HSCT. The possible occurrence of a graft-versus-tumour (GVT) effect in different solid tumours after allogeneic HSCT and the feasibility of a reduced intensity conditioning (RIC) were investigated. Patients with renal cell carcinoma (RCC, n=10), colon carcinoma (CC, n=6), breast cancer (n=1) or a Klatskin tumour of the liver (n=1) were treated with HSCT with a RIC consisting of Fludarabine and 2 Gray of total body irradiation (TBI). During the study, four patients died of transplantation-related complications between 45 and 160 days after HSCT and three patients died of tumour progression 92-323 days after HSCT. Almost total tumour regression was seen in the first patient with CC, but he died of pneumonia 4 months after HSCT. Partial responses in the lungs of one additional patient with CC and two patients with RCC, were seen. Among 624 patients receiving transplants between 1977-1997 at Huddinge Hospital, 254 patients surviving more than 12 months, were retrospectively analysed regarding clinical tolerance, that was defined as the absence of GVHD or rejection after withdrawal of immunosuppression. Patients who did not develop GVHD had discontinued immunosuppression according to the protocols. Children discontinued immunosuppression faster than adults and male recipients with immunised female donors discontinued immunosuppression later. Acute GVHD ...
Relation: I. Zetterquist H, Hentschke P, Thorne A, Wernerson A, Mattsson J, Uzunel M, Martola J, Albiin N, Aschan J, Papadogiannakis N, Ringden O (2001). A graft-versus-colonic cancer effect of allogeneic stem cell transplantation. Bone Marrow Transplant. 28(12): 1161-6. ::pmid::11803361; II. Hentschke P, Barkholt L, Uzunel M, Mattsson J, Wersall P, Pisa P, Martola J, Albiin N, Wernerson A, Soderberg M, Remberger M, Thorne A, Ringden O (2003). Low-intensity conditioning and hematopoietic stem cell transplantation in patients with renal and colon carcinoma. Bone Marrow Transplant. 31(4): 253-61. ::pmid::12621459; III. Hentschke P, Remberger M, Mattsson J, Barkholt L, Aschan J, Ljungman P, Ringden O (2002). Clinical tolerance after allogeneic hematopoietic stem cell transplantation: a study of influencing factors. Transplantation. 73(6): 930-6. ::pmid::11923695; IV. Hentschke P, Omazic B, Mattsson J, Nasman-Bjork I, Lundkvist I, Gigliotti D, Barkholt L, Ringdén O, Remberger M (2004). T cell receptor CDR3 repertoire after myeloablative and reduced intensity conditioning allogeneic haematopoietic stem cell transplantation. [Manuscript]; V. Omazic B, Hentschke P, Nasman-Bjork I, Mattsson J, Oxelius V, Ringdén O, Barkholt L, Permert J, Lundkvist I (2004). Reconstitution of the Ig heavy chain CDR4 repertoire after hematopoietic stem cell transplantation with myeloablative or reduced intensity conditioning regimens. [Manuscript]; 91-7349-800-9; 20040416hent; http://hdl.handle.net/10616/37919
Processing Request
No Comments.