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Nonmyeloablative stem cell transplantation in metastatic renal cell carcinoma: delayed graft-versus-tumor effect is associated with chimerism conversion but transplantation has high toxicity

Item Type:Article
Title:Nonmyeloablative stem cell transplantation in metastatic renal cell carcinoma: delayed graft-versus-tumor effect is associated with chimerism conversion but transplantation has high toxicity
Creators Name:Massenkeil, G. and Roigas, J. and Nagy, M. and Wille, A. and Stroszczynski, C. and Mapara, M.Y. and Loening, S. and Doerken, B. and Arnold, R.
Abstract:Seven out of 29 patients with metastatic renal cell carcinoma (RCC) considered eligible for allogeneic stem cell transplantation underwent nonmyeloablative stem cell transplantation (NST) from HLA-identical donors. Conditioning comprised cyclophosphamide, fludarabine and antithymocyte globulin. Prolonged mixed chimerism (MC) after engraftment converted to complete donor chimerism (CC) after infusion of donor lymphocytes and/or graft-versus-host disease (GvHD) in six patients. Five patients developed severe GvHD. Two of seven patients had a delayed tumor response after conversion to CC. After a median follow-up of 10 months (4–24 months), 5/7 patients are alive, one in very good partial remission (PR), one with stable and three with progressive disease. One of the seven patients died from sepsis in PR and 1/7 died from rapid tumor progression after sustained MC. None of the 22 nontransplanted patients responded to further therapies. Survival after 1 year was 59% in transplanted and 66% in nontransplanted patients (n.s.). A pooled data analysis from the literature suggests a graft-versus-tumor effect after transplant in patients with metastatic RCC, which becomes effective after chimerism conversion. Available data demonstrate high nonrelapse mortality in these patients. NST in RCC still has to be regarded as an investigational approach requiring careful patients' selection and longer follow-up within clinical studies.
Keywords:Renal Cell Carcinoma (RCC), Nonmyeloablative Stem Cell Transplantation (NST), Mixed Chimerism (MC), Graft-Versus-Host Disease (GvHD)
Source:Bone Marrow Transplantation
ISSN:0268-3369
Publisher:Nature Publishing Group (U.K.)
Volume:34
Number:4
Page Range:309-316
Date:1 August 2004
Official Publication:https://doi.org/10.1038/sj.bmt.1704587
PubMed:View item in PubMed

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