R. Childs et al., Regression of metastatic renal-cell carcinoma after nonmyeloablative allogeneic peripheral-blood stem-cell transplantation, N ENG J MED, 343(11), 2000, pp. 750-758
Citations number
29
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background: Since allogeneic stem-cell transplantation can induce curative
graft-versus-leukemia reactions in patients with hematologic cancers, we so
ught to induce analogous graft-versus-tumor effects in patients with metast
atic renal-cell carcinoma by means of nonmyeloablative allogeneic periphera
l-blood stem-cell transplantation.
Methods: Nineteen consecutive patients with refractory metastatic renal-cel
l carcinoma who had suitable donors received a preparative regimen of cyclo
phosphamide and fludarabine, followed by an infusion of a peripheral-blood
stem-cell allograft from an HLA-identical sibling or a sibling with a misma
tch of a single HLA antigen. Cyclosporine, used to prevent graft-versus-hos
t disease, was withdrawn early in patients with mixed T-cell chimerism or d
isease progression. Patients with no response received up to three infusion
s of donor lymphocytes.
Results: 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 ha
d died of transplantation-related causes, and eight from progressive diseas
e. In 10 patients (53 percent) metastatic disease regressed; 3 had a comple
te 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 consis
tent with a graft-versus-tumor effect.
Conclusions: Nonmyeloablative allogeneic stem-cell transplantation can indu
ce sustained regression of metastatic renal-cell carcinoma in patients who
have had no response to conventional immunotherapy. (N Engl J Med 2000;343:
750-8.) (C) 2000, Massachusetts Medical Society.