MD Anderson OncoLog, Volume 45, Number 7/8, July/August 2000 Page: 4
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Advances Expand Use of Allogeneic Transplantation
(Continued from page 3)All 13 patients are alive and in remis-
sion. "We have seen similar promising
results in chronic lymphocytic leuke-
mia, Richter's transformation, and
mantle cell lymphoma, and we are
also exploring this therapy for pa-
tients with AIDS-related lymphoma,"
Dr. Khouri added.
For many myeloid malignancies
in which traditional allogeneic
transplants have a proven benefit,
physicians at M. D. Anderson con-
tinue to recommend myeloablative
regimens for younger patients and
nonablative regimens for older ones,
who are most at risk for experiencing
the toxic effects of high-dose therapy.
The treatment-related mortality rate
is approximately 20% for all alloge-
neic transplants, and patients must
stay in the hospital for approximately
four months while their immune
systems recover and signs of infection
are monitored.
For large-cell lymphomas, mul-
tiple myelomas, and Hodgkin's
disease, allogeneic transplants are
recommended for those at high risk
for recurrence, but au-ologous
transplants are still preferred for
most patients. Autologous transplants
require a hospital stay of about a
month and have a treatment-related
mortality rate of less than 5%.
Autologous and allogeneic trans-
plants are also being studied in the
treatment and suppor: of autoim-
mune diseases and such solid tumors
as ovarian, breast, lung, and renal
cell cancers.
For both types of transplant, the
use of peripheral blood stem cells has
steadily increased over the past five
years. Today, almost all autologous
transplants and approximately 70%
of allogeneic transplants employ
peripheral blood stem cells rather
than bone marrow, according to
Martin Korbling, M.D., a professor
in the Department of Blood and
Marrow Transplantation. Dr. Korbling
led the development of the blood
stem cell collection program by
apheresis at M. D. Anderson, which
now performs approximately 1200
stem cell collections Each year.Donors are given granulocyte colony-
stimulating factor (G-CSF) to mobi-
lize stem cells from the bone marrow
into the peripheral bloodstream,
where the cells are harvested via a
procedure similar to simple platelet
collection.
According to Dr. Korbling, periph-
eral blood stem cells have several
advantages over bone marrow:
approximately four times more cells
can be collected, they allow faster
recovery of blood counts in recipi-
ents, and they contain more T cells
and thus may produce a stronger
immune reaction against the recipi-
ents' tumor cells. The disadvantage?
Recipients are more likely to experi-
ence chronic GVHD.
Several avenues are being investi-
gated to treat and prevent GVHD.
Photopheresis, which was originally
developed to treat cutaneous T cell
lymphoma, is now being studied as a
treatment for both acute and chronic
GVHD in a clinical trial led by Dr.
Anderlini and Michele Donato, M.D.,
an assistant professor in the Depart-
ment of Blood and Marrow Trans-
plantation. In addition, Dr. Korbling
and colleagues are investigating the
use of cytokines in donors and
recipients to mobilize or suppress
certain cells. These in vivo manipula-
tions could lead to faster engraft-
ment, less GVHD, and a stronger
graft-versus-malignancy response.
"The big picture is, technologi-
cally, we are able now to in vivo
manipulate the donor to collect the
graft, ex vivo manipulate the graft,
physically eliminating certain subsets
of cells, and then, whenever those
cells are transplanted, we can again
in vivo manipulate the patient by
giving certain cytokines," Dr. Korbling
said. "So, we have different strategies
available."
To reduce the risk of GVHD after
blood stem cell transplantation, Dr.
Donato is also studying the effects of
giving G-CSF to bone marrow donors
as an alternative to blood stem cell
transplantation. The hope is that G-
CSF-primed bone marrow cells will
grow just as quickly as the blood stem..._ _
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kDr. Richard E. Champlin, chairman (J rt;
Department of Blood and Marrow Trans-
plantation, has been collaborating with
Drs. Issa Khouri and Sergio Giralt in the
development of nonablative preparatory
regimens, which are allowing more patiE'ts
to receive allogeneic transplants.
cells but not produce as much GVED.
Other methods of enhancing
engraftment include generation of
cytotoxic T cells by ex vivo exposure
of donor cells to a patient's tumor
and gene therapy both to enable
recipients to better withstand pre-
parative chemotherapeutic regimens
and to introduce so-called "suicide
genes" that induce apoptosis in
transplanted cells that are not
providing benefit to a patient, a
strategy under development by
Associate Professor Steven Kornblau,
M.D., and Assistant Professor Frank
Marini, Ph.D., of the Department cf
Blood and Marrow Transplantatior .
"The important message is that
the whole field of blood and marrw
transplantation is probably the most
dynamic area in all of medicine,
where advances in chemotherapy,
immunosuppressive agents, genetic
therapy, and cellular therapy are all
coming together," said Dr. Champion.
"So it's an exciting place to work."'.
FOR MORE INFORMATION, contact Dr Champlin
at (713) 792-3618, Dr Khouri at (713)
792-3611, Dr Giralt at (713) 794-1034,
orDr Korbling at (713) 792-2808.4 / MD Anderson OncoLog
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University of Texas M.D. Anderson Cancer Center. MD Anderson OncoLog, Volume 45, Number 7/8, July/August 2000, periodical, July 2000; Houston, Texas. (https://texashistory.unt.edu/ark:/67531/metapth903446/m1/4/?q=houston: accessed June 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.