Graft-versus-myeloma effect: proof of principle.
The presence of a graft-versus-tumor effect has been well established in leukemia but not in multiple myeloma. A 40-year-old patient with myeloma refractory to standard chemotherapy and autologous transplantation received a matched unrelated T-cell-depleted transplant after conditioning with fractionated total-body irradiation, thiotepa, and cyclophosphamide. This procedure resulted in a transient and incomplete response with evidence of rapidly progressive disease within 2.5 months posttransplantation. The patient then received a small number of donor peripheral blood (PB) mononuclear cells (CD3 cells 1.2 x 10(6)/kg) without any further cytotoxic therapy. A complete remission was attained, lasting now for more than 14 months. The procedure was associated with severe acute and subsequently limited chronic graft-versus-host disease (GVHD). This report provides the first direct evidence of a graft-versus-myeloma effect after allogenic transplantation.
Tricot
G
G
Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, USA.
Vesole
D H
DH
Jagannath
S
S
Hilton
J
J
Munshi
N
N
Barlogie
B
B
D000328:Adult; D016026:Bone Marrow Transplantation; D017252:CD3 Complex / Q000032:analysis; D003520:Cyclophosphamide; D018450:Disease Progression; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006087:Graft vs Host Reaction; D006801:Humans; D017708:Leukocyte Transfusion; D008212:Lymphocyte Depletion; D009101:Multiple Myeloma / Q000276:immunology / Q000628:therapy*; D012074:Remission Induction; D016879:Salvage Therapy; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000637:transplantation*; D013852:Thiotepa; D014916:Whole-Body Irradiation
D017252:CD3 Complex; D003520:Cyclophosphamide; D013852:Thiotepa