Skip to main content

Advertisement

Log in

Novel approaches in allogeneic stem cell transplantation

  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Allogeneic transplantation remains an integral part of the management of hematologic malignancies. However, transplant-related mortality, graft-versus-host disease, and disease recurrence continue to be major limitations to successful transplant outcomes and challenges to investigators in the field. Newer approaches have focused on reduction of the intensity of the conditioning regimens, harnessing the antitumor effects of the allograft, and development of adoptive immunotherapy strategies to circumvent the limitations. These developments provide physicians with the ability to tailor transplants to specific patients and their diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Champlin R, Khouri I, Anderlini P, et al.: Nonmyeloablative preparative regimens for allogeneic hematopoietic transplantation: biology and current indications. Oncology 2003, 17:94–100; discussion 103–107.

    PubMed  Google Scholar 

  2. Grewal SS, Barker JN, Davies SM, Wagner JE: Unrelated donor hematopoietic cell transplantation: marrow or umbilical cord blood? Blood 2003, 101:4233–4244. Review article comparing marrow and umbilical cord stem cell sources. The authors explore these issues with regard to selected patient populations.

    Article  PubMed  CAS  Google Scholar 

  3. Aversa F, Berneman ZN, Locatelli F, et al.: Fourth international workshop on haploidentical transplants, Naples, Italy, July 8–10, 2004. Blood Cells Mol Dis 2004, 33:159–175.

    Article  PubMed  Google Scholar 

  4. Kernan NA: T-cell depletion for the prevention of graft-vshost disease. In Hematopoietic Cell Transplantation, edn 2. Edited by Thomas DE, Blume KG, Forman SJ. Boston: Blackwell Scientific Publications; 1999:186–196.

    Google Scholar 

  5. Wagner JE, Thompson JS, Carter SL, et al.: Effect of graft-versus-host disease prophylaxis on 3-year disease-free survival in recipients of unrelated donor bone marrow (T-cell Depletion Trial): a multi-centre, randomised phase II-III trial. Lancet, 2005. 366(9487): 733–741. Prospective randomized trial comparing transplant outcomes after T-cell depletion or unmodified transplants from unrelated donors in patients with acute and chronic leukemias.

    Article  PubMed  CAS  Google Scholar 

  6. Novitzky NN, Thomas V, Hale G, Waldmann H, et al.: Myeloablative conditioning is well tolerated by older patients receiving T-cell-depleted grafts. Bone Marrow Transplan 2005, 36:675–682.

    Article  CAS  Google Scholar 

  7. Schattenberg AV, Dolstra H: Cellular adoptive immunotherapy after allogeneic stem cell transplantation. Curr Opin Oncol 2005, 17:617–621.

    Article  PubMed  Google Scholar 

  8. Bethge W, Hegenbart U, Stuart MJ, et al.: Adoptive immunotherapy with donor lymphocyte infusions after allogeneic hematopoietic cell transplantation following nonmyeloablative conditioning. Blood 2004, 103:790–795.

    Article  PubMed  CAS  Google Scholar 

  9. McSweeney PA, Niederwieser D, Shizuru JA, et al.: Hematopoietic cell transplantation in older patients with hematologic malignancies: replacing high-dose cytotoxic therapy with graft-versus-tumor effects. Blood 2001, 97:3390–3400.

    Article  PubMed  CAS  Google Scholar 

  10. Hegenbart U, Niederwieser D, Sandmaier BM, et al.: Treatment for acute myelogenous leukemia by low-dose, total-body, iradiation-based conditioning and hematopoietic cell transplantation from related and unrelated donors. J Clin Oncol 2006, 24:444–453.

    Article  PubMed  CAS  Google Scholar 

  11. Moreau P, Fiere D, Bezwoda WR, et al.: Prospective randomized placebo-controlled study of granulocytemacrophage colony-stimulating factor without stem-cell transplantation after high-dose melphalan in patients with multiple myeloma. J Clin Oncol 1997, 15:660–666.

    PubMed  CAS  Google Scholar 

  12. Khouri IF, Saliba RM, Giralt SA, et al.: Nonablative allogeneic hematopoietic transplantation as adoptive immunotherapy for indolent lymphoma: low incidence of toxicity, acute graft-versus-host disease, and treatmentrelated mortality. Blood 2001, 98:3595–3599.

    Article  PubMed  CAS  Google Scholar 

  13. Schmitz NJ, Barrett J: Optimizing engraftment-source and dose of stem cells. Semin Hematol 2002, 39:3–14.

    Article  PubMed  Google Scholar 

  14. Bacigalupo A: Third EBMT/ AMGEN Workshop on Reduced-Intensity Conditioning Allogeneic Haemopoietic Stem Cell Transplants (RIC-HSCT), and panel consensus. Bone Marrow Transplant 2004, 33:691–696.

    Article  PubMed  CAS  Google Scholar 

  15. Giralt S, Thall PF, Khouri I, et al.: Melphalan and purine analog-containing preparative regimens: reduced-intensity conditioning for patients with hematologic malignancies undergoing allogeneic progenitor cell transplantation. Blood 2001, 97:631–637.

    Article  PubMed  CAS  Google Scholar 

  16. Girgis M, Hallemeier C, Blum W, et al.: Chimerism and clinical outcomes of 110 recipients of unrelated donor bone marrow transplants who underwent conditioning with low-dose, single-exposure total body irradiation and cyclophosphamide. Blood 2005, 105:3035–3041.

    Article  PubMed  CAS  Google Scholar 

  17. Stelljes M, Bornhauser M, Kroger M, et al.: Conditioning with 8-Gy total body irradiation and fludarabine for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia. Blood 2005, 106:3314–3321.

    Article  PubMed  CAS  Google Scholar 

  18. de Lima M, Couriel D, Thall PF, et al.: Once-daily intravenous busulfan and fludarabine: clinical and pharmacokinetic results of a myeloablative, reduced-toxicity conditioning regimen for allogeneic stem cell transplantation in AML and MDS. Blood 2004, 104:857–864.

    Article  PubMed  CAS  Google Scholar 

  19. Martino R, Perez-Simon JA, Moreno E, et al.: Reduced-intensity conditioning allogeneic blood stem cell transplantation with fludarabine and oral busulfan with or without pharmacokinetically targeted busulfan dosing in patients with myeloid leukemia ineligible for conventional conditioning. Biol Blood Marrow Transplant 2005, 11:437–447.

    Article  PubMed  CAS  Google Scholar 

  20. Boulad F, Jakubowski A, Castro-Malaspina H, et al.: A phase II trial of busulfan, melphalan, and fludarabine followed by allogeneic T-cell depleted hematopoietic stem cell transplants from HLA-identical, or HLA-non identical related or unrelated donors for the treatment of advanced hematopoietic malignancies. Presented at American Society for Hematology Annual Meeting, San Diego, CA, December 4–7, 2004.

  21. Clift RA, Buckner CD, Appelbaum FR, et al.: Allogeneic marrow transplantation in patients with acute myeloid leukemia in first remission: a randomized trial of two irradiation regimens [see comments]. Blood 1990, 76:1867–1871.

    PubMed  CAS  Google Scholar 

  22. de Lima M, Anagnostopoulos A, Munsell M, et al.: Nonablative versus reduced-intensity conditioning regimens in the treatment of acute myeloid leukemia and high-risk myelodysplastic syndrome: Dose is relevant for long-term disease control after allogeneic hematopoietic stem cell transplantation. Blood 2004, 104:865–872.

    Article  PubMed  CAS  Google Scholar 

  23. Michallet M, Bilger K, Garban F, et al.: Allogeneic hematopoietic stem-cell transplantation after nonmyeloablative preparative regimens: impact of pretransplantation and posttransplantation factors on outcome. J Clin Oncol 2001, 19:3340–3349.

    PubMed  CAS  Google Scholar 

  24. Champlin R, Khouri I, Shimoni A, et al.: Harnessing graftversus-malignancy: non-myeloablative preparative regimens for allogeneic haematopoietic transplantation, an evolving strategy for adoptive immunotherapy. Br J Haematol 2000, 111:18–29. Excellent review of GvM, and how NMAT is a platform for adoptive immunotherapy.

    Article  PubMed  CAS  Google Scholar 

  25. Escalon MP, Champlin RE, Saliba RM, et al.: Nonmyeloablative allogeneic hematopoietic transplantation: a promising salvage therapy for patients with non-Hodgkin’s lymphoma whose disease has failed a prior autologous transplantation. J Clin Oncol 2004, 22:2419–2423.

    Article  PubMed  Google Scholar 

  26. Aoudjhane M, Labopin M, Gorin NC, et al.: Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic haematopoietic stem cell transplantation for patients older than 50 years of age with acute myeloblastic leukemia: a retrospective survey from the Acute Leukemia Working Party (ALWP) of the European Group for Blood and Marrow Transplantation (EBMT). Leukemia 2005, 19:2304–2312.

    Article  PubMed  CAS  Google Scholar 

  27. Alyea EP, Kim HT, Ho V, et al.: Comparative outcome of nonmyeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients older than 50 years of age. Blood 2005, 105:1810–1814.

    Article  PubMed  CAS  Google Scholar 

  28. Scott BL, Sandmaier BM, Storer B, et al.: Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis. Leukemia 2005, 20:128–135.

    Article  Google Scholar 

  29. Baron F, Maris MB, Sandmaier BM, et al.: Graft-versus-tumor effects after allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning. J Clin Oncol 2005, 23:1993–2003.

    Article  PubMed  Google Scholar 

  30. Maris MB, Sandmaier BM, Storer BE, et al.: Unrelated donor granulocyte colony-stimulating factor-mobilized peripheral bood mononuclear cell transplantation after nonmyeloablative conditioning: the effect of postgrafting mycophenolate mofetil dosing. Biol Blood Marrow Transplant 2006, 12:454–465.

    Article  PubMed  CAS  Google Scholar 

  31. Maris MB Niederwieser D, Sandmaier BM, et al.: HLAmatched unrelated donor hematopoietic cell transplantation after nonmyeloablative conditioning for patients with hematologic malignancies. Blood 2003, 102:2021–2030.

    Article  PubMed  CAS  Google Scholar 

  32. van Besien K, Artz A, Smith S, et al.: Fludarabine, melphalan, and alemtuzumab conditioning in adults with standard-risk advanced acute myeloid leukemia and myelodysplastic syndrome. J Clin Oncol 2005, 23:5728–5738.

    Article  PubMed  CAS  Google Scholar 

  33. Kottaridis PD, Milligan DW, Chopra R, et al.: In vivo CAMPATH-1H prevents graft-versus-host disease following nonmyeloablative stem cell transplantation. Blood 2000, 96:2419–2425.

    PubMed  CAS  Google Scholar 

  34. Morris E, Thomson K, Craddock C, et al.: Outcomes after alemtuzumab-containing reduced-intensity allogeneic transplantation regimen for relapsed and refractory non-Hodgkin’s lymphoma. Blood 2004, 104:3865–3871.

    Article  PubMed  CAS  Google Scholar 

  35. Ho AY, Pagliuca A, Kenyon M, et al.: Reduced-intensity allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia with multilineage dysplasia using fludarabine, busulphan, and alemtuzumab (FBC) conditioning. Blood 2004, 104:1616–1623.

    Article  PubMed  CAS  Google Scholar 

  36. Chakraverty R, Peggs K, Chopra R, et al.: Limiting transplantation-related mortality following unrelated donor stem cell transplantation by using a nonmyeloablative conditioning regimen. Blood 2002, 99:1071–1078.

    Article  PubMed  CAS  Google Scholar 

  37. Ho VT, Soiffer RJ: The history and future of T-cell depletion as graft-versus-host disease prophylaxis for allogeneic hematopoietic stem cell transplantation. Blood 2001, 98:3192–204.

    Article  PubMed  CAS  Google Scholar 

  38. Frame JN, Collins NH, Cartagena T, et al.: T cell depletion of human bone marrow. Comparison of Campath-1 plus complement, anti-T cell ricin A chain immunotoxin, and soybean agglutinin alone or in combination with sheep erythrocytes or immunomagnetic beads. Transplantation 1989, 47:984–988.

    Article  PubMed  CAS  Google Scholar 

  39. Papadopoulos E, Ladanyi M, Emanuel D, et al.: Infusions of donor leukocytes to treat Epstein-Barr virus-associated lymphoproliferative disorders after allogeneic bone marrow transplantation. N Engl J Med 1994, 330:1185–1191.

    Article  PubMed  CAS  Google Scholar 

  40. Jakubowski AA, Castro-Malaspina H, Kernan N, et al.: Sustained engraftment of HLA-matched related, T-cell depleted, peripheral blood stem cell/bone marrow transplants in adults with hematologic malignancies without the use of antithymocyte globulin. Biol Blood Marrow Transplant 2003, 9:27.

    Article  Google Scholar 

  41. Laughlin MJ, Eapen M, Rubinstein P, et al.: Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia. N Engl J Med 2004, 351:2265–2275.

    Article  PubMed  CAS  Google Scholar 

  42. Barker JN, Weisdorf DJ, DeFor TE, et al.: Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancy. Blood 2005, 105:1343–1347.

    Article  PubMed  CAS  Google Scholar 

  43. Aversa F, Terenzi A, Tabilio A, et al.: Full haplotype-mismatched hematopoietic stem-cell transplantation: a phase II study in patients with acute leukemia at high risk of relapse. J Clin Oncol 2005, 23:3447–3454.

    Article  PubMed  Google Scholar 

  44. Collins RH Jr, Rogers ZR, Bennett M, et al.: Hematologic relapse of chronic myelogenous leukemia following allogeneic bone marrow transplantation: apparent graftversus-leukemia effect following abrupt discontinuation of immunosuppression. Bone Marrow Transplant 1992, 10:391

    PubMed  Google Scholar 

  45. Gale R, Horowitz M, Ash R: Identical-twin bone marrow transplants for leukemia. Ann Intern Med 1994, 120:646–652.

    PubMed  CAS  Google Scholar 

  46. Goldman J, Gale R, Horowitz M: Bone marrow transplantation for chronic myelogenous leukemia in chronic phase: increased risk for relapse associated with T-cell depletion. Ann Intern Med 1988, 108:806–814.

    PubMed  CAS  Google Scholar 

  47. Kolb HJ, Schattenberg A, Goldman JM, et al.: Graft-versus-leukemia effect of donor lymphocyte transfusions in marrow grafted patients. Blood 1995, 86:2041–2050.

    PubMed  CAS  Google Scholar 

  48. Ho V, Alyea E: Donor lymphocyte infusions. Adv Pharm 2004, 51:319–345.

    Article  CAS  Google Scholar 

  49. Leis J, Porter D: Unrelated donor leukocyte infusions to treat relapse after unrelated donor bone marrow transplantation. Leuk Lymphoma 2002, 43:9–17.

    Article  PubMed  Google Scholar 

  50. Collins RH Jr, Shpilberg O, Drobyski WR, et al.: Donor leukocyte infusions in 140 patients with relapsed malignancy after allogeneic bone marrow transplantation. J Clin Oncol 1997, 15:433–444.

    PubMed  Google Scholar 

  51. Dazzi F, Szydlo RM, Cross NC, et al.: Durability of responses following donor lymphocyte infusions for patients who relapse after allogeneic stem cell transplantation for chronic myeloid leukemia. Blood 2000, 96:2712–2716.

    PubMed  CAS  Google Scholar 

  52. Mackinnon S, Papadopoulos EB, Carabasi MH, et al.: Adoptive immunotherapy evaluating escalating doses of donor leukocytes for relapse of chronic myeloid leukemia after bone marrow transplantation: separation of graftversus-leukemia responses from graft-versus-host disease. Blood 1995, 86:1261–1268.

    PubMed  CAS  Google Scholar 

  53. Alyea E, Weller E, Schlossman R, et al.: T-cell-depleted allogeneic bone marrow transplantation followed by donor lymphocyte infusion in patients with multiple myeloma: induction of graft-versus-myeloma effect. Blood 2001, 98:934–939.

    Article  PubMed  CAS  Google Scholar 

  54. Kreiter S, Winkelmann N, Schneider PM, et al.: Failure of sustained engraftment after non-myeloablative conditioning with low-dose TBI and T cell-reduced allogeneic peripheral stem cell transplantation. Bone Marrow Transplant 2001, 28:157–161.

    Article  PubMed  CAS  Google Scholar 

  55. Peggs K, Thomson K, Hart DP, et al.: Dose-escalated donor lymphocyte infusions following reduced intensity transplantation: toxicity, chimerism, and disease responses. Blood 2004, 103:1548–1556.

    Article  PubMed  CAS  Google Scholar 

  56. Bonini C, Ferrari G, Verzeletti S, et al.: HSV-TK gene transfer into donor lymphocytes for control of allogeneic graft-versus-leukemia. Science 1997, 76: 1719–1724. First report of HSV-TK transduced donor T cells used for treatment of posttransplant relapse and Epstein-Barr virus lymphomas.

    Article  Google Scholar 

  57. Porter D, Levine BL, Bunin N, et al.: A phase 1 trial of donor lymphocyte infusions expanded and activated ex vivo via CD3/CD28 costimulation. Blood 2006, 107:1325–1331.

    Article  PubMed  CAS  Google Scholar 

  58. Morita Y, Heike Y, Kawakami M, et al.: eMonitoring of WT1-specific cytotoxic T lymphocytes after allogeneic hematopoietic stem cell transplantation. Int J Cancer 2006 Apr 4 [E-pub ahead of print].

  59. Tiberghien P, Ferrand C, Lioure B, et al.: Administration of herpes simplex-thymidine kinase-expressing donor T cells with a T-cell-depleted allogeneic marrow graft. Blood 2001, 97:63–72.

    Article  PubMed  CAS  Google Scholar 

  60. Marktel S, Magnani Z, Ciceri F, et al.: Immunologic potential of donor lymphocytes expressing a suicide gene for early immune reconstitution after hematopoietic T-cell-depleted stem cell transplantation. Blood 2003, 101:1290–1298.

    Article  PubMed  CAS  Google Scholar 

  61. Recchia A, Bonini C, Magnani Z, et al.: Retroviral vector integration deregulates gene expression but has no consequence on the biology and function of transplanted T cells. PNAS 2006, 103:1457–1462.

    Article  PubMed  CAS  Google Scholar 

  62. Kwak LW, Neelapu SS, Bishop MR: Adoptive immunotherapy with antigen-specific T cells in myeloma: a model of tumor-specific donor lymphocyte infusion. Semin Oncol 2004, 31:37–46.

    Article  PubMed  Google Scholar 

  63. Cathcart K, Pinilla-Ibarz J, Korontsvit T, et al.: A multivalent bcr-abl fusion peptide vaccination trial in patients with chronic myeloid leukemia. Blood 2004, 103:1037–1042.

    Article  PubMed  CAS  Google Scholar 

  64. Faber LM, van der Hoeven J, Goulmy E, et al.: Recognition of clonogenic leukemic cells, remission bone marrow and HLA-identical donor bone marrow by CD8+ or CD4+ minor histocompatibility antigen-specific cytotoxic T lymphocytes. J Clin Invest 1995, 96:877–883.

    PubMed  CAS  Google Scholar 

  65. Slavin S, Ackerstein A, Morecki S, et al.: Immunotherapy of relapsed resistant chronic myelogenous leukemia post allogeneic bone marrow transplantation with alloantigen pulsed donor lymphocytes. Bone Marrow Transplant 2001, 28:795–798.

    Article  PubMed  CAS  Google Scholar 

  66. Rooney CM, Smith CA, Ng CY, et al.: Use of gene-modified virus-specific T lymphocytes to control Epstein-Barr-virusrelated lymphoproliferation. Lancet 1995, 345:9–13.

    Article  PubMed  CAS  Google Scholar 

  67. Ruggeri L, Mancusi A, Capanni M, et al.: Exploitation of alloreactive NK cells in adoptive immunotherapy of cancer. Curr Opin Oncol 2005, 17:211–217.

    CAS  Google Scholar 

  68. Ruggeri L, Capanni M, Urbani E, et al.: Effectiveness of donor natural killer cell alloreactivity in mismatched hematopoietic transplants. Science 2002, 295:2097–2100.

    Article  PubMed  CAS  Google Scholar 

  69. Davies SM, Ruggieri L, DeFor T, et al.: Evaluation of KIR ligand incompatibility in mismatched unrelated donor hematopoietic transplants. Killer immunoglobulin-like receptor. Blood 2002, 100:3825–3827.

    Article  PubMed  CAS  Google Scholar 

  70. Passweg JR, Tichelli A, Meyer-Monard S, et al.: Purified donor NK-lymphocyte infusion to consolidate engraftment after haploidentical stem cell transplantation. Leukemia 2004, 18:1835–1888.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Esperanza B. Papadopoulos MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Papadopoulos, E.B., Jakubowski, A.A. Novel approaches in allogeneic stem cell transplantation. Curr Oncol Rep 8, 325–336 (2006). https://doi.org/10.1007/s11912-006-0054-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-006-0054-0

Keywords

Navigation