Separating Graft-versus-tumor from Graft-versus-host Reactions

Fassas, A.; Morris, Christine M.; Badros, Ashraf; Rhee, Frits van; Tricot, Guido

doi:10.1080/10428190290016818

Cited by 6 publications

(1 citation statement)

References 60 publications

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“…Fatal complications related to HSCT may occur as a direct result of the toxic cytoreductive preparation or because of immunosuppression ( 1 ). Complex immune reactions between donor and host tissues may also be fatal, but the graftversus-tumor effect may actually amplify the therapeutic benefi t of HSCT by decreasing the rates of tumor recurrence ( 2 ).…”

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confidence: 99%

Radiologic Imaging and Intervention for Gastrointestinal and Hepatic Complications of Hematopoietic Stem Cell Transplantation

Mahgerefteh

Sosna²,

Bogot³

et al. 2011

Radiology

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Hematopoietic stem cell transplantation (HSCT) is an increasingly available treatment option for patients with various oncologic, hematologic, and immunologic diseases. Although HSCT can be curative for some diseases, complications associated with this treatment limit its success and applicability. Gastrointestinal graft-versus-host disease (GVHD) and hepatic veno-occlusive disease are unique and deadly complications of HSCT. These diseases can mimic other HSCT complications, such as infection, hemorrhage, and hepatotoxicity with cholestasis, but GVHD and veno-occlusive disease require specific treatment. Early treatment improves the probability of treatment success. For these reasons, timely and accurate diagnosis is essential. Abdominal imaging and intervention play an important role in the early, minimally invasive diagnosis and treatment of GVHD and veno-occlusive disease. Imaging findings tend to be nonspecific, but common findings that may guide further management or establish a diagnosis in the clinical setting have been defined. In cases where the diagnosis is unclear and liver biopsy is required, image-guided transvenous liver biopsy may be a safer and more practical option than the transcutaneous approach. Image-guided interventions, including intraarterial steroid-injection therapy in severe, systemic steroid-refractory GVHD and transjugular intrahepatic portosystemic shunt placement in veno-occlusive disease with portal hypertension, have shown some promise in small, uncontrolled series. Larger, controlled studies are needed to define the role of these invasive procedures in this patient population.

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confidence: 99%

Radiologic Imaging and Intervention for Gastrointestinal and Hepatic Complications of Hematopoietic Stem Cell Transplantation

Mahgerefteh

Sosna²,

Bogot³

et al. 2011

Radiology

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Stem Cell Transplantation for AML

Bolaños-Meade

Jones

2007

Acute Myelogenous Leukemia

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Immunotherapy of cancer for the elderly patient: does allogeneic bone marrow transplantation after nonmyeloablative conditioning provide a new option?

Zöller

2004

Cancer Immunol Immunother

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The critical role of antigen-specific T cells in cancer immunotherapy has been amply demonstrated. Though success of clinical trials still remains far behind expectations, the continuous improvement in our understanding of the biology of the immune response will provide the basis for optimized cancer vaccines. This review focuses on active therapeutic vaccination after allogeneic bone marrow cell transplantation with nonmyeloablative conditioning. This approach could provide a major breakthrough in cancer immunotherapy, particularly of elderly patients. The senescent immune system, mainly the T-cell compartment, displays reduced responsiveness, and this has to be overcome if therapeutic vaccination is to be of benefit for the patient. Although the defects are quite well characterized, the inducing factors and ways to overcome them are still to be explored in more detail. Many questions also remain to be answered in the field of allogeneic bone marrow transplantation after nonmyeloablative conditioning to optimize this therapeutic setting in cancer immunotherapy. Current considerations to improve engraftment and to reduce graft-versus-host disease while strengthening graft-versus-tumor reactivity will be briefly reviewed. Finally, I will discuss whether tumor-reactive T cells can be "naturally" maintained during the process of T-cell maturation in the allogeneic host. Provided this hypothesis can be substantiated, a T-cell vaccine will meet a pool of virgin T cells in the allogeneically reconstituted host, which are tolerant toward the host but not anergized toward tumor antigens presented by MHC molecules of the host. Inevitably, the problem of the aged immune system would be circumvented.

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Separating Graft-versus-tumor from Graft-versus-host Reactions

Cited by 6 publications

References 60 publications

Radiologic Imaging and Intervention for Gastrointestinal and Hepatic Complications of Hematopoietic Stem Cell Transplantation

Radiologic Imaging and Intervention for Gastrointestinal and Hepatic Complications of Hematopoietic Stem Cell Transplantation

Stem Cell Transplantation for AML

Immunotherapy of cancer for the elderly patient: does allogeneic bone marrow transplantation after nonmyeloablative conditioning provide a new option?

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