Immunity for tumors and microbes after autotransplantation: if you build it, they will (not) come.
Relapses after autologous stem cell transplants for hematopoietic malignancies are frequent and post-transplant infections continue to cause significant post-transplant morbidity and even mortality. The post-transplant period is typically characterized by low lymphocyte counts and impaired immune cell function. Early restoration of immune function may contribute to better disease control and enhance protection from infections. Indeed the attainment of a 'minimal residual disease' status following high-dose therapy makes the early post-transplant period ideal for the introduction of antitumor immunotherapy. Attempts to generate immunity against tumor and microbial antigens after autotransplantation have included vaccinations, T cell infusions (both resting and activated) and combinations of vaccinations and adoptive T cell infusions. One successful strategy for generating robust immune responses against microbial antigens was the combination of pre and post-transplant immunizations along with an early (post-transplant) infusion of in vivo vaccine-primed and ex vivo co-stimulated autologous T cells. Whether this or similar strategies will lead to the generation of effective antitumor immunity is unknown. The lessons gained from efforts to rebuild immune system function in the setting of autotransplantation may also be applicable to the problem of restoring immunity in other immunodeficient groups such as patients with cancer or HIV disease and the elderly.
Rapoport
A P
AP
University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD 21201, USA. Arapoport@umm.edu
D000375:Aging / Q000276:immunology; D001424:Bacterial Infections / Q000209:etiology / Q000276:immunology* / Q000517:prevention & control; D001428:Bacterial Vaccines / Q000008:administration & dosage / Q000276:immunology; D019496:Cancer Vaccines / Q000008:administration & dosage / Q000276:immunology; D015658:HIV Infections / Q000276:immunology* / Q000628:therapy; D006801:Humans; D016219:Immunotherapy, Adoptive / Q000379:methods; D009369:Neoplasms / Q000276:immunology* / Q000628:therapy; D033581:Stem Cell Transplantation / Q000379:methods; D013601:T-Lymphocytes / Q000276:immunology / Q000637:transplantation; D014182:Transplantation, Autologous
D001428:Bacterial Vaccines; D019496:Cancer Vaccines