Graft-versus-lymphoma effects: clinical review, policy proposals, and immunobiology.
The indubitable existence of a graft-versus-lymphoma (GVL) effect is difficult to prove directly. This article reviews the difficulties in interpreting the current literature in this field and, with a number of caveats, argues for the existence of a clinically meaningful GVL effect in follicular, mantle cell, small lymphocytic, and Hodgkin lymphomas. The evidence, however, for a potent GVL effect in diffuse large-cell lymphoma and Burkitt lymphoma is not convincing. Policies for allografting in lymphoma are proposed on the basis of this evidence. The immunobiology of GVL effects is discussed--in particular, the expression of HLA class I and II and co-stimulatory molecules on lymphomas that influence the generation of alloreactive T cells--together with future directions in immunotherapy that may help to eradicate chemoresistant disease.
Department of Clinical Haematology and Medical Oncology, The Royal Melbourne Hospital, Melbourne, Australia. andrew.grigg@mh.org.au
Andrew
A
Grigg
David
D
Ritchie
D020350:Graft vs Tumor Effect / Q000276:immunology*; D006801:Humans; D008223:Lymphoma / Q000145:classification / Q000276:immunology*; D016393:Lymphoma, B-Cell / Q000276:immunology; D016399:Lymphoma, T-Cell / Q000276:immunology; D014184:Transplantation, Homologous / Q000276:immunology / Q000379:methods