Nonmyeloablative conditioning followed by hematopoietic cell allografting and donor lymphocyte infusions for patients with metastatic renal and breast cancer.
The feasibility and toxicity of allogeneic stem cell transplantation after nonmyeloablative conditioning including thiotepa, fludarabine, and cyclophosphamide have been investigated in 6 patients with breast cancer and 7 patients with renal cell cancer. The program included the use of escalating doses of donor lymphocyte infusions (DLI) and/or interferon alpha (IFNalpha) for patients showing no tumor response and no graft-versus-host disease (GVHD). Patients were at high risk of transplant-related mortality (TRM) because of age, advanced stage, and previous treatments. We observed a partial remission in 4 renal cancer and in 2 breast cancer patients (one at the molecular level in the bone marrow), occurring after cyclosporine withdrawal or after DLI and/or IFNalpha. All the responses were accompanied by the occurrence of acute GVHD. We conclude that reduced-intensity allogeneic stem cell transplantation is a feasible procedure in renal and breast cancer, and that the exploitation of graft-versus-tumor effect after DLI is a promising finding.
Bregni
Marco
M
Bone Marrow Transplant Unit and Gene Therapy Program and the Division of Pathology, Istituto H San Raffaele, Milano, Italy. marco.bregni@hsr.it
Dodero
Anna
A
Peccatori
Jacopo
J
Pescarollo
Alessandra
A
Bernardi
Massimo
M
Sassi
Isabella
I
Voena
Claudia
C
Zaniboni
Alberto
A
Bordignon
Claudio
C
Corradini
Paolo
P
D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002292:Carcinoma, Renal Cell / Q000628:therapy*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009679:Nuclear Family; D017713:Platelet Transfusion; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000276:immunology* / Q000379:methods; D016896:Treatment Outcome