reduced-intensity stem cell transplantation in two cases of metastatic renal cell carcinoma
TRANSCRIPT
International Journal of Urology
(2003)
10,
615
Blackwell Science, LtdOxford, UKIJUInternational Journal of Urology0919-81722003 Blackwell Publishing Asia Pty LtdNovember 20031011615Editorial Comment
RIST for metastatic RCCY Tomita
Editorial Comment
Reduced-intensity stem cell transplantation in two cases of metastatic renal cell carcinoma
There have been few effective treatment options forcytokine-refractory renal cell carcinoma (RCC). Areport of non-myeloablative allogeneic stem cell trans-plantation, which has recently been more popularlytermed as reduced intensity stem cell transplantation(RIST), to RCC patients by Childs
et al
. in the
NewEngland Journal of Medicine
in 1999 created a sensa-tion. Nine of 18 cytokine-refractory cases experiencedtumor regression, which seemed to be a durableresponse in many of the cases.
1
Other institutions haverevealed similar promising results.
2,3
However, inanother study of eight patients, none of the patientsshowed response.
4
In the present issue of the
Interna-tional Journal of Urology
Aoyama
et al
. report twocases of RCC treated with RIST. The two patientsrevealed progression of disease besides achieving com-plete chimera within 100 days after the transplantation.However, in one patient, transient pulmonary regressionwas observed along with Graft-versus-host disease(GVHD). In Japan, at the end of 2002, 22 patients hadbeen treated with RIST at eight institutions. The bestresponses of this series were three partial responses,nine stable disease and three progressive disease (pers.comm.).
Discrepancy of these effects may be the result of twofactors: varied treatment protocol and patient selection.Each treatment protocol, however, achieved completechimera with several exceptional cases. Among thereported cases, tumor regression was experienced morefrequently concomitant with GVHD as reported byAoyama
et al.
in the present issue of this journal. Pres-ence or absence of GVHD, therefore, might affectantitumor response relevant to conditioning and admin-istration of immunosuppressants to control GVHD.Balance between tumor cell proliferation and lysis
caused by immune cells originated from allogeneicblood stem cells determine clinical responses, i.e.change of size of metastatic lesions. It is conceivablethat tumors with high proliferation activity, such as sar-comatoid RCC, may overcome immune cell attackresulting in tumor progression despite the presence ofgraft-versus-tumor reaction. Careful patient selectionand standardization of a standard protocol would con-tribute to an increased response rate for advancedRCC.
Yoshihiko Tomita
MD
Department of UrologyYamagata University School of Medicine
Yamagata, Japan
References
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