Allogeneic hematopoietic stem cell transplantation with a reduced-intensity conditioning regimen for treatment of metastatic renal cell carcinoma: single institution experience with a minimum 1-year follow-up.
OBJECTIVE
The aim of this study was to evaluate the safety and efficacy of allogeneic hematopoietic stem cell transplantation with a reduced-intensity conditioning regimen (RIST) for interferon-alpha-refractory metastatic renal cell carcinoma (RCC).


METHODS
Of 26 patients referred to the National Cancer Center Hospital for possible RIST between June 2000 and April 2002, an HLA-identical relative was identified for 12 patients. Nine patients underwent RIST. The conditioning regimen consisted of fludarabine 180 mg/m2 or cladribine 0.66 mg/kg, plus busulfan 8 mg/kg and rabbit antithymocyte globulin 5 mg/kg. Graft-vs-host disease (GVHD) prophylaxis was cyclosporine alone.


RESULTS
All patients achieved engraftment without grade III to IV nonhematologic regimen-related toxicity. All patients achieved complete donor-type chimerism without donor lymphocyte infusion by day 60. Four patients developed acute GVHD, and four developed chronic GVHD. One patient (11%) achieved partial response. As of July 2003, six patients were alive at median follow-up of 681 days. The actuarial overall survival rate was 89% at 1 year and 74% at 2 years. The overall survival rate tended to be higher in the 12 patients with a matched donor than in the other 14 patients without a matched donor (p = 0.088).


CONCLUSIONS
Our RIST procedure is feasible without severe toxicity. The efficacy of RIST for RCC should be confirmed in phase II/III clinical trials.
Nakagawa
Tohru
T
Urology Division, National Cancer Center Hospital, Tokyo, Japan.
Kami
Masahiro
M
Hori
Akiko
A
Kim
Sung-Won
SW
Murashige
Naoko
N
Hamaki
Tamae
T
Kishi
Yukiko
Y
Fujimoto
Hiroyuki
H
Matsuoka
Naoki
N
Okajima
Eijiro
E
Komiyama
Motokiyo
M
Tobisu
Ken-ichi
K
Wakayama
Toshio
T
Uike
Naokuni
N
Tajima
Kinuko
K
Makimoto
Atsushi
A
Mori
Shinichiro
S
Tanosaki
Ryuji
R
Takaue
Yoichi
Y
Kakizoe
Tadao
T
D000208:Acute Disease; D000328:Adult; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000628:therapy*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D006650:Histocompatibility Testing; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009392:Nephrectomy; D018579:Patient Selection; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000276:immunology / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome