title: Cellular immune therapy for refractory cancers: novel therapeutic strategies.
abstract: OBJECTIVE
  Allogeneic stem cell transplantation is curative for certain cancers, but the high doses of chemotherapy and radiotherapy may lead to toxicity. This review summarizes the field of cellular immune therapy using very-low-dose conditioning for refractory cancers.
  
  
  METHODS
  In our initial study, we treated 25 patients with refractory cancers with 100 cGy total body irradiation followed by allogeneic, nonmobilized peripheral blood cells. Eighteen patients received sibling and seven patients received unrelated cord blood stem cells.
  
  
  RESULTS
  None of the 13 patients with solid tumors achieved donor chimerism or had a sustained response. Twelve patients with hematologic malignancies were treated, 1 received a cord blood transplant and 11 received sibling donor cells. Nine of these 11 patients achieved donor chimerism, ranging from 5% to 100%. Four patients had sustained complete remission of their cancers. The patients who received cord blood transplants did not respond. Development of chimerism correlated with total previous myelotoxic chemotherapy (p < 0.001). We review additional studies in this area, including data in the haploidentical and unrelated donor setting. The data presented comprises studies performed at the four institutions represented by the authors, and a review of other pertinent studies in this area.
  
  
  CONCLUSIONS
  Cellular immune therapy is an emerging application of transplantation therapy, which may be appropriate for refractory cancers. New studies in solid tumors, and with alternative donors, will expand the application of this new and promising treatment.
authors.affiliation: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, 02114, USA. kballen@partners.org
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Gerald
authors.initials: G
authors.lastname: Colvin
authors.forename: Bimalangshu R
authors.initials: BR
authors.lastname: Dey
authors.forename: David
authors.initials: D
authors.lastname: Porter
authors.forename: Peter
authors.initials: P
authors.lastname: Westervelt
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Spitzer
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Quesenberry
mesh_terms: D000818:Animals; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D016219:Immunotherapy, Adoptive / Q000379:methods*; D051379:Mice; D016879:Salvage Therapy / Q000379:methods; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome