title: Allogeneic hematopoietic transplantation as adoptive immunotherapy. Induction of graft-versus-malignancy as primary therapy.
abstract: An immune-mediated graft-versus-malignancy effect is important to prevent relapse after allogeneic bone marrow transplant for a range of hematologic malignancies and potentially some solid tumors. Graft-versus-leukemia (GVL) effects as seen in response to donor lymphocyte infusions have been most prominent against indolent malignancies including chronic myelogenous leukemia, chronic lymphocytic leukemia, and low-grade lymphoma. Acute myelogenous leukemia and multiple myeloma may also respond. An alternative strategy for allogeneic transplantation is to avoid the toxicity of high-dose chemoradiotherapy and use a relatively nontoxic, nonablative preparative regimen to achieve engraftment, allowing subsequent infusion of additional donor lymphocytes to mediate GVL. Fludarabine-based nonablative chemotherapy agents, using standard dose combinations, produce moderate myelosuppression but are sufficiently immunosuppressive to allow engraftment of an allogeneic hematopoietic transplant and generation of graft-versus-malignancy effects.
authors.affiliation: Department of Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, Houston, USA. rchampli@mdacc.tmc.edu
authors.forename: R
authors.initials: R
authors.lastname: Champlin
authors.forename: I
authors.initials: I
authors.lastname: Khouri
authors.forename: S
authors.initials: S
authors.lastname: Kornblau
authors.forename: F
authors.initials: F
authors.lastname: Marini
authors.forename: P
authors.initials: P
authors.lastname: Anderlini
authors.forename: N T
authors.initials: NT
authors.lastname: Ueno
authors.forename: J
authors.initials: J
authors.lastname: Molldrem
authors.forename: S
authors.initials: S
authors.lastname: Giralt
mesh_terms: D000951:Antigens, Neoplasm; D020350:Graft vs Tumor Effect; D019337:Hematologic Neoplasms / Q000276:immunology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016219:Immunotherapy, Adoptive; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D000951:Antigens, Neoplasm