Regression of metastatic renal-cell carcinoma after nonmyeloablative allogeneic peripheral-blood stem-cell transplantation
| Autor: | Richard Childs, Allen Chernoff, Nathalie Contentin, Erkut Bahceci, David Schrump, Susan Leitman, Elizabeth J. Read, John Tisdale, Cynthia Dunbar, W. Marston Linehan, Neal S. Young, Emmanuel Clave, Diane Epperson, Virginia Mayo, A. John Barrett |
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| Rok vydání: | 2000 |
| Předmět: |
Oncology
Adult Male medicine.medical_specialty Transplantation Conditioning medicine.medical_treatment Graft vs Host Disease Pilot Projects Transplantation Chimera Hematopoietic stem cell transplantation Transplantation Immunology Internal medicine Carcinoma medicine Humans Transplantation Homologous Lymphocytes Carcinoma Renal Cell Preparative Regimen Aged Probability business.industry Histocompatibility Testing Graft vs Tumor Effect Hematopoietic Stem Cell Transplantation General Medicine Middle Aged medicine.disease Donor Lymphocytes Survival Analysis Kidney Neoplasms Surgery Fludarabine Transplantation Multivariate Analysis Cytokines Female business medicine.drug |
| Zdroj: | The New England journal of medicine. 343(11) |
| ISSN: | 0028-4793 |
| Popis: | Since allogeneic stem-cell transplantation can induce curative graft-versus-leukemia reactions in patients with hematologic cancers, we sought to induce analogous graft-versus-tumor effects in patients with metastatic renal-cell carcinoma by means of nonmyeloablative allogeneic peripheral-blood stem-cell transplantation.Nineteen consecutive patients with refractory metastatic renal-cell carcinoma who had suitable donors received a preparative regimen of cyclophosphamide and fludarabine, followed by an infusion of a peripheral-blood stem-cell allograft from an HLA-identical sibling or a sibling with a mismatch of a single HLA antigen. Cyclosporine, used to prevent graft-versus-host disease, was withdrawn early in patients with mixed T-cell chimerism or disease progression. Patients with no response received up to three infusions of donor lymphocytes.At the time of the last follow-up, 9 of the 19 patients were alive 287 to 831 days after transplantation (median follow-up, 402 days). Two had died of transplantation-related causes, and eight from progressive disease. In 10 patients (53 percent) metastatic disease regressed; 3 had a complete response, and 7 had a partial response. The patients who had a complete response remained in remission 27, 25, and 16 months after transplantation. Regression of metastases was delayed, occurring a median of 129 days after transplantation, and often followed the withdrawal of cyclosporine and the establishment of complete donor-T-cell chimerism. These results are consistent with a graft-versus-tumor effect.Nonmyeloablative allogeneic stem-cell transplantation can induce sustained regression of metastatic renal-cell carcinoma in patients who have had no response to conventional immunotherapy. |
| Databáze: | OpenAIRE |
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