Stem cell transplantation in the treatment of renal cell carcinoma

Metastatic renal cell carcinoma prognosis is extremely poor and the survival time of patients in general more than a year. There was no significant effect of their chemotherapy. To IL-2 and interferon α-based immunotherapy can only make a small part of the lives of patients and to extend treatment response rate of less than 20%.

Has confirmed that allogeneic bone marrow transplantation can have a powerful effect of graft-versus-leukemia (graft-versus-leukemia effect), blood system for tumor treatment can produce better results. Another person of interest is confirmed in a number of solid tumors such as metastatic breast cancer can also occur in patients with graft-versus-tumor effect. Immunotherapy for renal cell carcinoma and a higher degree of sensitivity, so that scholars have different gene through cell transplantation for the treatment of renal cell carcinoma.

University of California at San Diego, a scholar of peripheral blood stem cell transplantation in the treatment of advanced kidney cancer effects were observed, and the results of the study published in the "New England Journal of Medicine."

To study the age of 18 to 75-year-old study by the Organization for renal biopsy confirmed, and through the imaging method for the adoption of advanced renal cell carcinoma can no longer radical resection surgery patients; at the same time there is a requirement in patients with HLA typing the same There is only one site or a different brothers and sisters.

Before transplantation cyclophosphamide, fludarabine and / or ATG to carry out pre-and at the same time before and after transplantation in the application of intravenous or oral cyclosporine to prevent graft rejection or graft-versus-host reaction.

For stem cells in the peripheral stem cell collection prior to acceptance of granulocyte colony stimulating factor (G-CSF) treatment in order to collect sufficient number of stem cells.

According to the transplant donor stem cells into the speed and extent of deciding whether to disable cyclosporine as well as lymphocyte infusion.

Complete remission is defined as able to detect the disappearance of all tumor metastasis; partial remission is defined as the transfer of cancer to reduce the diameter of at least 50% of the time to maintain at least 30 days.

Application of PCR method of evaluation of the micro-satellite for the district to determine - were set by the state of the extent of the formation; according to the International Bone Marrow Transplant Registry to determine the standard graft-versus-host reaction of the extent of the problem.

The results showed: A total of 19 patients with advanced renal cell carcinoma patients to participate in the study, the average age was 48 years old. Follow-up period, 19 patients received peripheral blood stem cell transplant after the 9 cases of survival 287-831 days (average follow-up time of 402 days). 3 cases of complete remission in patients with post-transplant 27,25 and 16 months was to maintain the state of complete remission; 7 cases of partial remission of 4 cases of patients in the transplant after 9-19, when the tumor has been no progress. 2 transplant patients because of complications related to the death; 8 cases of patients with tumors progress. A total of 10 cases (53%) of patients with metastatic renal cell carcinoma there have been varying degrees of improvement in metastasis (including lymph nodes, adrenal gland, liver, subcutaneous tissue, bone, lung, abdominal, pelvic and chest wall of metastasis, etc.) There have been dissipated. 19 cases of patients in complete remission for 3 and the remaining 7 cases of partial remission for patients. Transfer of cancer regression occurred later, at an average of 129 days after the transplant, and are usually out in the cyclosporine as well as the formation of complete donor chimerism after the T cells.

Multivariate analysis showed that only acute graft-versus-host reaction tumor regression is the only predictor. The results of this and graft-versus-tumor effect with. At the same time, also found that the only clear-cell kidney cancer treatment should have a response.

Although this study has some limitations, but without the traditional treatment of immune response in patients with metastatic renal cell carcinoma, non-allogeneic bone marrow transplantation of peripheral blood stem cell transplantation can renal cell carcinoma metastatic to achieve long-term subsided.