Indium-111-labelled donor-lymphocyte infusion by way of hepatic artery and radio-frequency ablation against liver metastases of renal and colon carcinoma after allogeneic hematopoietic stem-cell transplantation.
BACKGROUND
In patients with metastatic solid cancer, antitumor effects occur after allogeneic stem-cell transplantation (SCT). However, this treatment is not as effective in the liver as against pulmonary and lymph-node metastases. To intensify the effect of donor-lymphocyte infusions (DLI) against liver metastases, intra-arterial (IA) cell injection by way of the hepatic artery (HA) can be used.


METHODS
To trace infused cells, three patients with colorectal, three with renal, and one with breast carcinoma were treated with Indium-111 (111-In)-oxinate-labeled lymphocytes. Four patients received the DLI IA, all after radio-frequency ablation (RFA) of liver metastases. Three patients with other metastases received 111-In DLI intravenously (IV). One of them had RFA before SCT.


RESULTS
Localization of the IA 111-In DLI activity on scintigrams homed to the liver. After IA injection, the liver to sternum ratio of radioactivity was higher compared with IV injection. Cells (CD3+, 19+, and 56+) of donor origin in biopsies of liver metastasis in two patients treated with IA injection increased to 80% to 100%. Two of four patients treated using the IA DLI showed stable size and number of liver metastases for 5 and 21 months, respectively. Both are alive 18 and 34 months after SCT. Two of three patients receiving DLI IV are doing well, with a stable metastatic disease or still without metastases 21 and 20 months after cell infusions (26 and 34 months after SCT), respectively. Three patients died because of progressive disease.


CONCLUSIONS
When infused by way of the HA, 111-In-labeled lymphocytes home to the liver and its metastases. The liver metastasis infiltrating cells of donor origin increased. DLI by way of the HA combined with RFA may be used to treat liver metastases after SCT.
Barkholt
Lisbeth
L
Centre for Allogeneic Stem Cell Transplantation, Karolinska Hospital Huddinge, Karolinska Institutet, SE-141 86 Stockholm, Sweden. lisbeth.barkholt@labmed.ki.se
Danielsson
Rimma
R
Calissendorff
Bertil
B
Svensson
Leif
L
Malihi
Reza
R
Remberger
Mats
M
Uzunel
Mehmet
M
Thörne
Anders
A
Ringdén
Olle
O
D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007205:Indium Radioisotopes / Q000493:pharmacokinetics*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000556:secondary*; D017710:Lymphocyte Transfusion / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011846:Radio Waves; D033581:Stem Cell Transplantation; D014057:Tomography, X-Ray Computed; D018183:Transplantation Chimera; D014184:Transplantation, Homologous
D007205:Indium Radioisotopes