Autologous Graft-versus-Tumor Effect: Reality or Fiction?

Abstract

In contrast to allogeneic hematopoietic stem cell transplantation, the current dogma is not an evidence of graft-versus-tumor effect in autologous hematopoietic stem cell transplantation; thus, it is assumed that autologous hematopoietic stem cell transplantation only relies on the high-dose chemotherapy to improve clinical outcomes. However, recent studies argue in favor of the existence of an autologous graft-versus-tumor without the detrimental complications of graft-versus-host disease due to the nonspecific immune response from the infused donor alloreactive immune effector cells in allogeneic hematopoietic stem cell transplantation. Herein, this paper reviews the clinical evidence of an autologous graft-versus-tumor effect based on the autograft collected and infused host immune effector cells and host immunity recovery after autologous hematopoietic stem cell transplantation affecting clinical outcomes in cancer patients.

A Young Patient with Refractory Multiple Myeloma and Dialysis-Dependent Renal Failure has been Cured by Non-Cryopreserved Autologous Stem Cell Transplantation Followed by Live-Related Kidney Transplantation

“…The high relapse rates reported after auto-HSCT have been attributed to the assumption that graft versus tumor (GVT) effect is lacking in the auto-HSCT setting [23]. Recent studies argue in favor of the existence of an autologous GVT effect without the detrimental complications of graft versus host disease (GVHD) [23].…”

“…Recent studies argue in favor of the existence of an autologous GVT effect without the detrimental complications of graft versus host disease (GVHD) [23]. Although graft versus myeloma (GVM) effect has been well documented in the allogeneic HSCT setting, recent studies have provided evidence of its existence even in the setting of auto-HSCT [23][24][25][26][27]. MM represents a genuine malignancy with disrupted immune surveillance.…”

Natural killer cells in patients with hematologic malignancies, solid tumors and in recipients of hematopoietic stem cell transplantation

“…Autologous GVT effects and autologous GVHD: In the setting of autologous HSCT, not only GVT effect but also biopsy proven GVHD can be encountered [113][114][115][116][117][118]. Hence, GHVD is an increasingly recognized complication of autologous HSCT [113,118].…”

“…(4) female gender; (5) high CD34 + stem cell dose infused; (6) achievement of high levels of absolute lymphocyte count (ALC) after autologous HSCT; and (7) use of certain novel agents such as bortezomib, lenalidomide, pomalidomide and alemtuzumab [113][114][115][117][118][119]. Autologous GHVD may occur spontaneously, but can be induced by a number of immunosuppressive drugs [113].…”

Autologous graft versus myeloma: it’s not a myth

“…An array of early clinical stud-ies have reported a positive correlation between lymphocyte count recovery after autologous SCT and OS, suggesting an autologous GVT effect. Many of these studies were done retrospectively and involved a wide range of diseases, including MM, B cell/T cell NHL, Hodgkin lymphoma (HL), mantle cell lymphoma, acute myeloid leukemia, metastatic breast cancer, and ovarian cancer (5). These studies found that, among the autograft immune effector cells, CD4 + T cells (in MM), NK cells (in diffuse large B cell lymphoma), and cytotoxic DCs (in classical HL) are associated with better clinical outcomes.…”