Successful treatment of metastatic renal cell carcinoma with a nonmyeloablative allogeneic peripheral-blood progenitor-cell transplant: Evidence for a graft-versus-tumor effect

Purpose: A 50-year-old man developed progressive pulmonary metastasis resis tant to interferon alfa-2b treatment 7 months after he underwent left nephr ectomy for stage III renal cell carcinoma. We performed a nonmyeloablative allogeneic peripheral-blood stem-cell transplant in this patient to exploit a possible graft-versus-tumor effect from allogeneic lymphocytes. Materials and Methods: The conditioning regimen consisted of fludarabine an d cyclophosphamide followed by a T-cell replete, granulocyte-colony stimula ting-factor-mobilized peripheral-blood stem-cell transplant from his HLA-id entical brother. Cyclosporine was administered from days -4 to +45 to preve nt graft rejection and acute graft-versus-host disease (GVHD). Results: Serial polymerase chain reaction analysis of hematopoietic lineage -specific minisatellites initially showed mixed chimerism in CD14(+) and CD 15(+) myeloid cells, CD3(+) T cells, and CD34(+) progenitor cells, with rap id conversion to 100% donor T-cell chimerism by day +60 and 100% donor myel oid cells by day +100. Serial computed tomography scans of the chest showed stable disease at day +30, blight regression of pulmonary lesions at day 63, and complete disappearance of ail pulmonary metastatic disease by day 110, Mild transient acute GVHD disease of the skin occurred on day +60 and limited chronic GVHD of the skin occurred by day +200. Conclusion: The complete regression of metastatic disease, which has now be en maintained for more than 1 year, is compatible with a graft-versus-tumor effect. (C) 1999 by American Society of Clinical Oncology.