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Allogeneic Stem Cell Transplantation

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Immunotherapy for Pediatric Malignancies

Abstract

Allogeneic stem cell transplantation in malignant diseases has evolved as a treatment option for patients with otherwise incurable diseases. The principle of this treatment is a significant tumor reduction by pretransplant chemotherapy or irradiation and immunological consolidation by various effector cells of the adaptive as well as of the innate immune system. The role of Graft versus Host disease (GvHD) and the concomitant Graft versus Tumor (GvT) effects is discussed and therapeutic approaches exploiting alloreactive T cell responses and ways to separate GvHD from GvT are shown. Antitumor response mechanisms that are also induced by alloreactive Natural Killer (NK) cells and γδ + T-cells belonging to the innate immune system are described. The innate donor-derived immune system might significantly contribute to the anti-tumor effects of allogeneic transplantation and the selection of donors will extend beyond classical high resolution typing of HLA alleles and finding the best matched HLA identical donor. The Killer Inhibitory Immunoglobuline-like Receptor (KIR) system is almost as polymorphic but independent from the HLA system and allows the selection of the optimal donor for certain malignant diseases. Especially in haploidentical transplantion, the KIR system plays an important role and new donor selection strategies might also apply in the future for the treatment of refractory solid tumors.

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  1. Hematology/Oncology, University Children’s Hospital Tübingen, Tübingen, Germany

    Patrick Schlegel M.D., Christian Seitz M.D., Peter Lang M.D. & Rupert Handgretinger M.D.

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  1. Patrick Schlegel M.D.
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  2. Christian Seitz M.D.
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  4. Rupert Handgretinger M.D.
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Schlegel, P., Seitz, C., Lang, P., Handgretinger, R. (2018). Allogeneic Stem Cell Transplantation. In: Gray, J., Marabelle, A. (eds) Immunotherapy for Pediatric Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-319-43486-5_3

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